MEDICARE: JOHN K LEE DDS PLLC

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

General Provider Information

NPI Number	:	1316558802
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN K LEE DDS PLLC

Provider Business Mailing Address
First Line	:	3300 E 1ST AVE STE 580
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80206-5818
Country	:	US
Telephone Number	:	303-495-9977
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 E 1ST AVE STE 580
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80206-5818
Country	:	US
Telephone Number	:	303-495-9977
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. JOHN KEUNHEE LEE
Credential	:	DDS
Telephone Number	:	303-495-9977

Provider Enumeration Date	:	08/10/2020
Last Update Date	:	08/10/2020

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