Provider Demographics
NPI:1427127299
Name:LEE, CONRAD K (DMD)
Entity type:Individual
Prefix:DR
First Name:CONRAD
Middle Name:K
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 1:19 CHENELL DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-8539
Mailing Address - Country:US
Mailing Address - Phone:603-223-3344
Mailing Address - Fax:
Practice Address - Street 1:19 CHENELL DR
Practice Address - Street 2:SUITE 2
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-8539
Practice Address - Country:US
Practice Address - Phone:603-223-3344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH25911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice