Provider Demographics
NPI:1538181995
Name:LEE, KENNETH A (DDS)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:A
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 1:338 HARRIS HILL RD
Mailing Address - Street 2:SUITE # 103
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7407
Mailing Address - Country:US
Mailing Address - Phone:716-631-3221
Mailing Address - Fax:
Practice Address - Street 1:338 HARRIS HILL RD
Practice Address - Street 2:SUITE # 103
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7407
Practice Address - Country:US
Practice Address - Phone:716-631-3221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0426361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice