Lee, Bryan D

Lee, Bryan D is an sole proprietor health care provider with primary practice located at 360 E. Main St. , Rexburg ID 83440. He recently has 3 registered licenses in different health care specialties including Dental Providers / General Practice, Dental Providers / Oral and Maxillofacial Surgery, Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery. Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery is his primary health care specialty. Lee, Bryan D can be contacted via phone (208) 356-5959.

Contact Information

Primary practice address
360 E. Main St. Rexburg ID 83440
Phone: (208) 356-5959
Fax: (208) 356-5559
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X D-3542 Idaho
Dental Providers / Oral and Maxillofacial Surgery 1223S0112X D-3542-OS Idaho
Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery 204E00000X M-11482 Idaho

Profile Details

NPI number 1790905495
LBN Legal business name Lee, Bryan D
Credentials DDS, MD
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 26th, 2007
Last updated May 29th, 2015 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1790905495 NPPES
Idaho MEDICAID 806068200

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