Healthcare Provider Details

I. General information

NPI: 1699199687
Provider Name (Legal Business Name): JOSEPH J LEE D D S A PROFESSIONAL DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2014
Last Update Date: 02/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 W EL CAMINO REAL
MOUNTAIN VIEW CA
94040-2643
US

IV. Provider business mailing address

74 W EL CAMINO REAL
MOUNTAIN VIEW CA
94040-2643
US

V. Phone/Fax

Practice location:
  • Phone: 650-988-9458
  • Fax:
Mailing address:
  • Phone: 650-988-9458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH J LEE
Title or Position: OWNER
Credential: DDS
Phone: 650-988-9458