MEDICARE: DANIEL LEE DMD, PC

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	FL0024113	GA

General Provider Information

NPI Number	:	1750714986
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANIEL LEE DMD, PC

Provider Business Mailing Address
First Line	:	4427 CARNES ST
Second Line	:
City	:	ACWORTH
State	:	GA
Zip	:	30101-5305
Country	:	US
Telephone Number	:	770-974-4146
Fax Number	:	770-974-4950

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	:	770-974-4950

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DANIEL LEE
Credential	:	D.M.D.
Telephone Number	:	770-974-4146

Provider Enumeration Date	:	08/12/2013
Last Update Date	:	08/10/2023

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