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General NPI Number Information
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NPI Number | 1699199687
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Entity Type | Organization
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Legal Business Name | JOSEPH J LEE D D S A PROFESSIONAL DENTAL CORPORATION
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Dates
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Enumeration Date | 02/11/2014
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Last Update Date | 02/11/2014
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Provider Practice Location Address
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Address Line | 74 W EL CAMINO REAL
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City | MOUNTAIN VIEW
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State | CA
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Zip | 94040-2643
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Country | US
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Telephone | 650-988-9458
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Fax |
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Provider Business Mailing Address
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Address Line | 74 W EL CAMINO REAL
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City | MOUNTAIN VIEW
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State | CA
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Zip | 94040-2643
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Country | US
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Telephone | 650-988-9458
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOSEPH J LEE
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Credential | DDS
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Telephone | 650-988-9458
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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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 |
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License Number State |
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