MEDICARE: LOVELEE DENTAL, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1285405993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOVELEE DENTAL, LLC

Provider Business Mailing Address
First Line	:	7380 SPOUT SPRINGS RD STE 120
Second Line	:
City	:	FLOWERY BRANCH
State	:	GA
Zip	:	30542-7535
Country	:	US
Telephone Number	:	770-965-5548
Fax Number	:

Provider Business Practice Location Address
First Line	:	7380 SPOUT SPRINGS RD STE 120
Second Line	:
City	:	FLOWERY BRANCH
State	:	GA
Zip	:	30542-7535
Country	:	US
Telephone Number	:	770-965-5548
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ DENTIST
Name	:	JEMIN LEE
Credential	:	DMD
Telephone Number	:	770-965-5548

Provider Enumeration Date	:	01/11/2024
Last Update Date	:	01/16/2024

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