MEDICARE: STEPHEN M. 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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1528673415
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHEN M. LEE, DDS

Provider Business Mailing Address
First Line	:	345 9TH ST STE 304
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94607-6523
Country	:	US
Telephone Number	:	510-272-0967
Fax Number	:	510-272-0969

Provider Business Practice Location Address
First Line	:	345 9TH ST STE 304
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94607-6523
Country	:	US
Telephone Number	:	510-272-0967
Fax Number	:	510-272-0969

Authorized Official
Title or Position	:	OWNER
Name	:	STEPHEN MING LEE
Credential	:	DDS
Telephone Number	:	510-272-0967

Provider Enumeration Date	:	09/09/2020
Last Update Date	:	09/16/2020

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