Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | 04536 | NH |
Y | 1223P0106X | Oral and Maxillofacial Pathology | DN1858064 | MA |
NPI | 1225478753 |
---|---|
Provider Name | Jason W Lee |
First Address | Boston, MA 02114 |
Second Address | Boston, MA 02114 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2013 |
Last Update Date | 27/01/2020 |