Provider Demographics
NPI:1992879365
Name:LEE, BARRY MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:MICHAEL
Last Name:LEE
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 10 ST
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-6116
Mailing Address - Country:US
Mailing Address - Phone:707-822-3584
Mailing Address - Fax:707-822-3374
Practice Address - Street 1:1017 10 ST
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-6116
Practice Address - Country:US
Practice Address - Phone:707-822-3584
Practice Address - Fax:707-822-3374
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21157122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist