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General NPI Number Information
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NPI Number | 1720465602
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Entity Type | Organization
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Legal Business Name | LEE FAMILY DENTSTRY, LLC
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Dates
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Enumeration Date | 04/30/2015
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Last Update Date | 04/30/2015
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Provider Practice Location Address
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Address Line | 138 BATTLEWOOD DR
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City | FORT OGLETHORPE
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State | GA
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Zip | 30742-4006
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Country | US
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Telephone | 706-686-6011
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Fax | 706-820-6854
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Provider Business Mailing Address
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Address Line | 138 BATTLEWOOD DR
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City | FORT OGLETHORPE
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State | GA
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Zip | 30742-4006
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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 | OWNER
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Name | DR. JACOB LEE
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Credential | DDS
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Telephone | 706-686-6011
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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 | DN011116
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN013134
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License Number State | GA
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