Individual
STEVEN B LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1320 MEDICAL PARK DR, FORT WAYNE, IN 46825-5844
(260) 471-1222
(260) 471-1724
Mailing address
1320 MEDICAL PARK DR, FORT WAYNE, IN 46825-5844
(260) 471-1222
(260) 471-1724
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
12008803
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BLUE CROSS BLUE SHIE
000000373783
IN
Enumeration date
06/25/2007
Last updated
07/08/2007
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