MEDICARE: BRENDAN 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	DDS111889	CA

General Provider Information

NPI Number	:	1811872781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDAN LEE DDS

Provider Business Mailing Address
First Line	:	816 2ND ST
Second Line	:
City	:	LOS BANOS
State	:	CA
Zip	:	93635-4124
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	816 2ND ST
Second Line	:
City	:	LOS BANOS
State	:	CA
Zip	:	93635-4124
Country	:	US
Telephone Number	:	209-812-0041
Fax Number	:

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

Provider Enumeration Date	:	08/08/2025
Last Update Date	:	08/08/2025

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