MEDICARE: JUNG LEE DDS

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	1223G0001X	General Practice Dentistry	6605192	UT
2	122300000X	Dentist	25159	TX

General Provider Information

NPI Number	:	1114118601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUNG LEE DDS

Provider Business Mailing Address
First Line	:	2651 TEXAS DR
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75062-7016
Country	:	US
Telephone Number	:	972-255-4164
Fax Number	:	801-226-4754

Provider Business Practice Location Address
First Line	:	2651 TEXAS DR
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75062-7016
Country	:	US
Telephone Number	:	972-255-4164
Fax Number	:	972-252-1580

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

Provider Enumeration Date	:	08/08/2007
Last Update Date	:	01/27/2025

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Directions to “ JUNG LEE DDS” Practice Location

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