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General NPI Number Information
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NPI Number | 1760507388
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Entity Type | Organization
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Legal Business Name | LEE DENTAL CORPORATION
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 10/13/2008
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Provider Practice Location Address
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Address Line | 728 PACIFIC AVE SUITE 610
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City | SAN FRANCISCO
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State | CA
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Zip | 94133
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Country | US
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Telephone | 415-398-2828
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Fax | 415-398-7099
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Provider Business Mailing Address
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Address Line | 728 PACIFIC AVE SUITE 610
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City | SAN FRANCISCO
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State | CA
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Zip | 94133
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Country | US
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Telephone | 415-398-2828
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Fax | 415-398-7099
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. HENRY S LEE
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Credential | DDS
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Telephone | 415-398-2828
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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 | 57678
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License Number State | CA
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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 | 39675
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License Number State | CA
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