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General NPI Number Information
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NPI Number | 1336479963
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Entity Type | Organization
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Legal Business Name | MIKE M. LEE, DDS, INC.
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Dates
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Enumeration Date | 01/04/2010
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Last Update Date | 05/18/2021
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Provider Practice Location Address
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Address Line | 41797 NICOLE LN
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City | TEMECULA
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State | CA
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Zip | 92591-3870
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Country | US
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Telephone | 951-695-7733
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Fax |
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Provider Business Mailing Address
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Address Line | 41797 NICOLE LN
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City | TEMECULA
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State | CA
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Zip | 92591-3870
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Country | US
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Telephone | 951-695-7333
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. MIKE LEE
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Credential | DDS
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Telephone | 951-695-7733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 50076
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License Number State | CA
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