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General NPI Number Information
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NPI Number | 1740894146
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Entity Type | Organization
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Legal Business Name | DR GRACE E LEE DMD LTD
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Dates
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Enumeration Date | 09/02/2020
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Last Update Date | 09/02/2020
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Provider Practice Location Address
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Address Line | 4142 N SHERIDAN RD
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City | CHICAGO
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State | IL
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Zip | 60613-2007
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Country | US
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Telephone | 773-348-6600
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Fax |
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Provider Business Mailing Address
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Address Line | 1160 S MICHIGAN AVE APT 2203
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City | CHICAGO
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State | IL
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Zip | 60605-2961
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Country | US
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Telephone | 267-971-6031
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | EUN HYE LEE
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Credential |
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Telephone | 267-971-6031
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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 |
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License Number State |
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