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General NPI Number Information
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NPI Number | 1336492891
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Entity Type | Individual
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Provider Name | CHARLES J LEE DDS
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Gender | Male
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Dates
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Enumeration Date | 10/22/2012
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 14711 PRINCETON AVE STE 12
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City | MOORPARK
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State | CA
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Zip | 93021-1469
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Country | US
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Telephone | 805-529-4821
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Fax | 915-744-5746
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Provider Business Mailing Address
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Address Line | 26893 BOUQUET CANYON RD # 152
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City | SANTA CLARITA
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State | CA
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Zip | 91350-3500
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Country | US
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Telephone | 310-845-6705
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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 | 28453
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 105729
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 28453
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number | 2051
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License Number State | CA
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