MEDICARE: MICHAEL LEE DDS

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	DDS36968	CA
2	1223G0001X	General Practice Dentistry	36938	CA

General Provider Information

NPI Number	:	1427151547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL LEE DDS

Provider Business Mailing Address
First Line	:	P.O. BOX 22210
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94623-2210
Country	:	US
Telephone Number	:	510-535-4000
Fax Number	:	510-535-4225

Provider Business Practice Location Address
First Line	:	3050 E 16TH ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94601-2319
Country	:	US
Telephone Number	:	510-535-4700
Fax Number	:	510-535-4283

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	08/23/2013

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