Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
BRYAN D LEE, DDS, MD
Deactivated Sole ProprietorBRYAN D LEE, DDS, MD is a Oral & Maxillofacial Surgery (Physician) healthcare provider located in REXBURG, Idaho. NPI 1790905495 is deactivated in the NPPES registry. Verify at CMS.
Oral & Maxillofacial Surgery (Physician) · REXBURG, ID
This NPI has been deactivated.
The record was deactivated on July 17, 2007.
Deactivated NPIs are no longer valid for billing or credentialing. The provider may have retired, changed practice status, or had their NPI administratively deactivated.
Verify current licensure status with the NPPES NPI Registry or the relevant state medical board before relying on this record.
Registration Details
- NPI Number
- 1790905495
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Apr 26, 2007 (0.22404371584699 yrs)
- Last Updated
- May 29, 2015
- Deactivated
- Jul 17, 2007
- Licenses
-
D-3542 (ID)D-3542-OS (ID)M-11482 (ID)
- Sole Proprietor
- Yes
Practice Information
- Address
-
360 E. MAIN ST.REXBURG, ID, 83440Browse ID providers · Browse ZIP 83440
- Phone
- 2083565959
- Fax
- 2083565559
- Primary Specialty
-
Oral & Maxillofacial Surgery (Physician)
204E00000X
- Additional Specialty
- Oral & Maxillofacial Surgery
- Additional Specialty
- Oral & Maxillofacial Surgery (Physician)
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.