Provider Demographics
NPI:1396700910
Name:LEE, STANLEY SONG (DMD)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:SONG
Last Name:LEE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-2404
Mailing Address - Country:US
Mailing Address - Phone:860-278-8181
Mailing Address - Fax:860-278-8183
Practice Address - Street 1:128 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-2404
Practice Address - Country:US
Practice Address - Phone:860-278-8181
Practice Address - Fax:860-278-8183
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT78011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice