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General NPI Number Information
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NPI Number | 1265518815
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Entity Type | Individual
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Provider Name | SOO H LEE DDS
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Gender | Female
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Dates
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Enumeration Date | 10/27/2006
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Last Update Date | 01/18/2008
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Provider Practice Location Address
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Address Line | 1635 N BALDWIN RD
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City | PALATINE
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State | IL
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Zip | 60074-1703
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Country | US
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Telephone | 847-359-8886
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Fax | 847-963-2331
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Provider Business Mailing Address
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Address Line | 5267 BRENTWOOD CIR
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City | LONG GROVE
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State | IL
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Zip | 60047-5188
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Country | US
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Telephone | 847-383-5448
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN16982
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019.027246
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License Number State | IL
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