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General NPI Number Information
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NPI Number | 1114607900
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Entity Type | Individual
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Provider Name | JADEN SOPHIEN LEE DMD, PHD
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Gender | Male
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Dates
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Enumeration Date | 07/18/2023
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Last Update Date | 07/18/2023
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Provider Practice Location Address
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Address Line | 1011 N UNIVERSITY AVE RM 3370
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City | ANN ARBOR
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State | MI
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Zip | 48109-1078
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Country | US
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Telephone | 734-764-2700
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Fax |
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Provider Business Mailing Address
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Address Line | 3022 SIGNATURE BLVD APT F
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City | ANN ARBOR
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State | MI
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Zip | 48103-6455
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901601820
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License Number State | MI
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