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General NPI Number Information
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NPI Number | 1457760746
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Entity Type | Organization
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Legal Business Name | LEE FAMILY DENTISTRY
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Dates
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Enumeration Date | 08/12/2014
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Last Update Date | 08/12/2014
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Provider Practice Location Address
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Address Line | 2176 MACLAND RD
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City | DALLAS
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State | GA
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Zip | 30157-5190
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Country | US
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Telephone | 770-445-1081
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Fax | 770-445-7737
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Provider Business Mailing Address
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Address Line | 2176 MACLAND RD
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City | DALLAS
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State | GA
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Zip | 30157-5190
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Country | US
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Telephone | 770-445-1081
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Fax | 770-445-7737
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Authorized Official
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Title or Position | OWNER / DENTIST
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Name | DR. JASON MICHEAL STEVENS
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Credential | D.M.D.
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Telephone | 770-445-1081
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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 | DN012439
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License Number State | GA
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