Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | IL |
NPI | 1659361566 |
---|---|
Provider Name | Dr. Richard Erik Lee |
First Address | Urbana, IL 61801-4957 |
Second Address | Champaign, IL 61820-3013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2005 |
Last Update Date | 08/07/2007 |