Healthcare Provider Details

I. General information

NPI: 1225137045
Provider Name (Legal Business Name): SUSAN H LEE DMD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 02/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3280 HOWELL MILL RD NW STE 121
ATLANTA GA
30327-4111
US

IV. Provider business mailing address

3280 HOWELL MILL RD NW STE 121
ATLANTA GA
30327-4111
US

V. Phone/Fax

Practice location:
  • Phone: 404-355-8557
  • Fax:
Mailing address:
  • Phone: 404-355-8557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN011872
License Number StateGA

VIII. Authorized Official

Name: DR. SUSAN HAE-KYUNG LEE
Title or Position: DENTIST/OWNER
Credential: DMD
Phone: 404-355-8557