Healthcare Provider Details

I. General information

NPI: 1003315458
Provider Name (Legal Business Name): CASEY PAUL LEE DDS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2018
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

348 TARAVAL ST
SAN FRANCISCO CA
94116-1953
US

IV. Provider business mailing address

348 TARAVAL ST
SAN FRANCISCO CA
94116-1953
US

V. Phone/Fax

Practice location:
  • Phone: 415-564-6800
  • Fax:
Mailing address:
  • Phone: 415-564-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberDDS104492
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDDS104492
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: