Provider Demographics
NPI:1285741827
Name:LEE, BRUCE CARTER (DDS)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:CARTER
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12776 S WEST BAY SHORE DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-5451
Mailing Address - Country:US
Mailing Address - Phone:231-929-0522
Mailing Address - Fax:231-929-8773
Practice Address - Street 1:12776 S WEST BAY SHORE DR
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-5451
Practice Address - Country:US
Practice Address - Phone:231-929-0522
Practice Address - Fax:231-929-8773
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0147251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice