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General NPI Number Information
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NPI Number | 1922272004
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Entity Type | Organization
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Legal Business Name | JONATHAN D. LEE, D.D.S., INC.
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Dates
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Enumeration Date | 04/18/2008
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Last Update Date | 09/28/2011
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Provider Practice Location Address
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Address Line | 555 MARIN ST SUITE 260
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-4236
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Country | US
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Telephone | 805-370-0110
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Fax | 805-370-3770
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Provider Business Mailing Address
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Address Line | 555 MARIN ST SUITE 260
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-4236
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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 | PRESIDENT
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Name | JONATHAN LEE
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Credential | D.D.S.
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Telephone | 805-370-0110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 49924
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License Number State | CA
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