MEDICARE: HILLSIDE DENTAL CENTER PLLC

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	:	1548102122
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HILLSIDE DENTAL CENTER PLLC

Provider Business Mailing Address
First Line	:	12227 PINE BLUFFS WAY STE 107
Second Line	:
City	:	PARKER
State	:	CO
Zip	:	80134-4493
Country	:	US
Telephone Number	:	720-515-8168
Fax Number	:

Provider Business Practice Location Address
First Line	:	12227 PINE BLUFFS WAY STE 107
Second Line	:
City	:	PARKER
State	:	CO
Zip	:	80134-4493
Country	:	US
Telephone Number	:	720-515-8168
Fax Number	:

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	JAMES YEOMYUNG LEE
Credential	:	DMD
Telephone Number	:	321-278-3272

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	04/06/2026

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