Healthcare Provider Details

I. General information

NPI: 1972016293
Provider Name (Legal Business Name): MICHELLE K. LEE, DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2017
Last Update Date: 09/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4840 IRVINE BLVD STE 106
IRVINE CA
92620-1962
US

IV. Provider business mailing address

4840 IRVINE BLVD STE 106
IRVINE CA
92620-1962
US

V. Phone/Fax

Practice location:
  • Phone: 949-885-9300
  • Fax:
Mailing address:
  • Phone: 949-885-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number48497
License Number StateCA

VIII. Authorized Official

Name: DR. MICHELLE K LEE
Title or Position: OWNER
Credential: DDS
Phone: 949-885-9300