Whalio Doctors

NPI 1790905495

Bryan D Lee, DDSMD

Practitioner Oral & Maxillofacial Surgery (D.M.D.) Rexburg, ID

Practice location

Address
360 E. Main St., Rexburg, ID 83440
Phone
(208) 356-5959
Fax
(208) 356-5559

Registered specialties (3)

Oral & Maxillofacial Surgery (D.M.D.) Primary
Allopathic & Osteopathic Physicians Taxonomy 204E00000X Licence M-11482 (ID)
General Practice Dentistry
Dental Providers Taxonomy 1223G0001X Licence D-3542 (ID)
Oral and Maxillofacial Surgery (Dentist)
Dental Providers Taxonomy 1223S0112X Licence D-3542-OS (ID)

Registry record

NPI
1790905495
Entity type
Individual
Sex (as registered)
Male
NPI issued
26 Apr 2007
Record last updated
29 May 2015

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.