Healthcare Provider Details

I. General information

NPI: 1508901323
Provider Name (Legal Business Name): LEE AND DUBANSKI DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4750 ROCKLIN RD SUITE 100
ROCKLIN CA
95677-3334
US

IV. Provider business mailing address

4750 ROCKLIN RD SUITE 100
ROCKLIN CA
95677-3334
US

V. Phone/Fax

Practice location:
  • Phone: 916-315-3558
  • Fax: 916-315-9301
Mailing address:
  • Phone: 916-315-3558
  • Fax: 916-315-9301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number35666
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. GERTRUDE LEE
Title or Position: PRES.
Credential: DMD
Phone: 916-315-3558