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General NPI Number Information
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NPI Number | 1750505202
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Entity Type | Organization
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Legal Business Name | CHILDREN'S DENTAL SURGERY CENTER, A DENTAL PRACTICE OF DRS. LEE AND MU
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1610 W EDINGER AVE SUITE C
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City | SANTA ANA
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State | CA
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Zip | 92704-4339
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Country | US
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Telephone | 714-432-7337
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Fax |
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Provider Business Mailing Address
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Address Line | 1610 W EDINGER AVE SUITE C
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City | SANTA ANA
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State | CA
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Zip | 92704-4339
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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 | DENTAL DIRECTOR
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Name | RICHARD LEE
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Credential | DMD
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Telephone | 714-432-7337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 44807
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License Number State | CA
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