Provider Demographics
NPI:1194420679
Name:LEE, TIMOTHY HOJOON (DMD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:HOJOON
Last Name:LEE
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 8TH ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-7901
Mailing Address - Country:US
Mailing Address - Phone:703-919-5069
Mailing Address - Fax:
Practice Address - Street 1:1033 RIVER RD
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-1351
Practice Address - Country:US
Practice Address - Phone:201-224-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI03002000122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist