MEDICARE: ANDREW D. LEE DDS, A DENTAL CORPORATION

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	1223E0200X	Endodontics

General Provider Information

NPI Number	:	1780270736
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDREW D. LEE DDS, A DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	2917 SALVIO ST STE C
Second Line	:
City	:	CONCORD
State	:	CA
Zip	:	94519-2580
Country	:	US
Telephone Number	:	925-687-2500
Fax Number	:

Provider Business Practice Location Address
First Line	:	2917 SALVIO ST STE C
Second Line	:
City	:	CONCORD
State	:	CA
Zip	:	94519-2580
Country	:	US
Telephone Number	:	925-687-2500
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANDREW D LEE
Credential	:	DDS
Telephone Number	:	410-456-6826

Provider Enumeration Date	:	12/14/2020
Last Update Date	:	07/27/2023

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