MEDICARE: DANIEL JIN LEE DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN013434	GA

General Provider Information

NPI Number	:	1043397805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL JIN LEE DMD

Provider Business Mailing Address
First Line	:	8100 SAINT MARLO COUNTRY CLUB PKWY
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30097-1625
Country	:	US
Telephone Number	:	770-454-8432
Fax Number	:	678-990-9799

Provider Business Practice Location Address
First Line	:	4569 DALLAS STREET
Second Line	:
City	:	ACWORTH
State	:	GA
Zip	:	30101
Country	:	US
Telephone Number	:	770-974-4146
Fax Number	:	770-974-4146

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	08/11/2023

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