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General NPI Number Information
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NPI Number | 1376793133
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Entity Type | Organization
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Legal Business Name | S LEE DENTAL CORPORATION
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Dates
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Enumeration Date | 09/29/2008
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Last Update Date | 10/06/2023
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Provider Practice Location Address
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Address Line | 23571 LAKE DR
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City | CRESTLINE
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State | CA
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Zip | 92325-9432
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Country | US
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Telephone | 909-338-1782
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3009
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City | CRESTLINE
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State | CA
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Zip | 92325-3009
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Country | US
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Telephone | 909-883-1782
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Fax |
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Authorized Official
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Title or Position | EMPLOYER
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Name | SEAN S LEE
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Credential | DDS
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Telephone | 909-338-1782
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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 | 36259
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License Number State | CA
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