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General NPI Number Information
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NPI Number | 1497095749
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Entity Type | Organization
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Legal Business Name | LEE,N.GRACE DDS,INC
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Dates
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Enumeration Date | 02/25/2013
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Last Update Date | 02/25/2013
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Provider Practice Location Address
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Address Line | 7743 WEST LN SUITE C5
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City | STOCKTON
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State | CA
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Zip | 95210-3348
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Country | US
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Telephone | 209-474-1101
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Fax | 209-474-9734
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Provider Business Mailing Address
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Address Line | 7743 WEST LN SUITE C5
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City | STOCKTON
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State | CA
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Zip | 95210-3348
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Country | US
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Telephone |
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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. NANJOO LEE
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Credential |
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Telephone | 209-552-9158
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 47930
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License Number State | CA
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