MEDICARE: DR. DAVIS MIN 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	1223G0001X	General Practice Dentistry	DDS109624	CA

General Provider Information

NPI Number	:	1811768245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVIS MIN LEE DMD

Provider Business Mailing Address
First Line	:	41871 MONTALLEGRO ST
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93536-2987
Country	:	US
Telephone Number	:	661-917-1306
Fax Number	:

Provider Business Practice Location Address
First Line	:	1629 W AVENUE J STE 103
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93534-2850
Country	:	US
Telephone Number	:	661-948-7722
Fax Number	:

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

Provider Enumeration Date	:	01/15/2024
Last Update Date	:	01/15/2024

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