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General NPI Number Information
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NPI Number | 1124174602
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Entity Type | Organization
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Legal Business Name | BRANDON W LEE DDS PC
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4444 W NORTHERN AVE SUITE A3
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City | GLENDALE
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State | AZ
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Zip | 85301
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Country | US
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Telephone | 623-842-1075
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Fax | 623-931-5881
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Provider Business Mailing Address
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Address Line | 4444 W NORTHERN AVE SUITE A3
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City | GLENDALE
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State | AZ
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Zip | 85301
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Country | US
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Telephone | 623-842-1075
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Fax | 623-931-5881
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Authorized Official
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Title or Position | OWNER
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Name | WONSEOK LEE
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Credential | DDS
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Telephone | 623-842-1075
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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 | 4338
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License Number State | AZ
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