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General NPI Number Information
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NPI Number | 1841547775
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Entity Type | Organization
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Legal Business Name | LEE & WIDODO DDS INC
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Dates
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Enumeration Date | 08/09/2012
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Last Update Date | 08/09/2012
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Provider Practice Location Address
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Address Line | 1532 SAN BERNARDINO AVE STE A1
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City | POMONA
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State | CA
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Zip | 91767-3559
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Country | US
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Telephone | 909-670-1100
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Fax | 909-398-0026
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Provider Business Mailing Address
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Address Line | 1532 SAN BERNARDINO AVE STE A1
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City | POMONA
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State | CA
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Zip | 91767-3559
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Country | US
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Telephone | 909-670-1100
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Fax | 909-398-0026
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Authorized Official
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Title or Position | DDS/OWNER
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Name | JEFFREY LEE
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Credential |
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Telephone | 909-670-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 49927
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License Number State | CA
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