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General NPI Number Information
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NPI Number | 1386034247
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Entity Type | Organization
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Legal Business Name | BADII LEE DENTAL CORPORATION, INC.
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Dates
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Enumeration Date | 01/30/2015
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Last Update Date | 11/08/2016
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Provider Practice Location Address
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Address Line | 2360 PACIFIC AVE
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City | LONG BEACH
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State | CA
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Zip | 90806-3051
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Country | US
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Telephone | 562-595-0731
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Fax | 562-595-6462
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Provider Business Mailing Address
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Address Line | 19762 MACARTHUR BLVD. 100
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City | IRVINE
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State | CA
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Zip | 92612-7209
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Country | US
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Telephone | 949-596-8100
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Fax | 562-424-9807
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Authorized Official
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Title or Position | PRESIDENT
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Name | DANIEL HARVEY LEE
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Credential | DDS, MBA
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Telephone | 949-596-8100
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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 | 56861
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License Number State | CA
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