Healthcare Provider Details

I. General information

NPI: 1841350741
Provider Name (Legal Business Name): EE SHEN LEE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 05/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 LEXINGTON DR
LODI CA
95242-4782
US

IV. Provider business mailing address

1520 LEXINGTON DR
LODI CA
95242-4782
US

V. Phone/Fax

Practice location:
  • Phone: 617-875-7546
  • Fax:
Mailing address:
  • Phone: 617-875-7546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number56452
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number20660
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: