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General NPI Number Information
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NPI Number | 1124491121
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Entity Type | Organization
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Legal Business Name | CHARLES C. LEE DDS, INC
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Dates
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Enumeration Date | 11/12/2015
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Last Update Date | 11/12/2015
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Provider Practice Location Address
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Address Line | 901 E OHIO AVE
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City | ESCONDIDO
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State | CA
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Zip | 92025-3422
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Country | US
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Telephone | 760-745-4241
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Fax | 562-296-2110
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Provider Business Mailing Address
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Address Line | 901 E OHIO AVE
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City | ESCONDIDO
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State | CA
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Zip | 92025-3422
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Country | US
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Telephone | 760-745-4241
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Fax | 562-296-2110
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Authorized Official
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Title or Position | OWNER
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Name | CHARLES C LEE
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Credential | DDS
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Telephone | 760-745-4241
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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 | 48496
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License Number State | CA
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