Healthcare Provider Details

I. General information

NPI: 1861474298
Provider Name (Legal Business Name): JEMIN LEE DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7380 SPOUT SPRINGS RD STE 120
FLOWERY BRANCH GA
30542-7535
US

IV. Provider business mailing address

830 BENTGRASS CT
DACULA GA
30019-3111
US

V. Phone/Fax

Practice location:
  • Phone: 770-965-5548
  • Fax: 770-965-5528
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN122619
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN122619
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: