MEDICARE: LEE DENTAL CARE 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	9869	WA

General Provider Information

NPI Number	:	1871652602
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEE DENTAL CARE PLLC

Provider Business Mailing Address
First Line	:	3031 ORLEANS ST
Second Line	:	SUITE 103
City	:	BELLINGHAM
State	:	WA
Zip	:	98226-3541
Country	:	US
Telephone Number	:	360-734-3011
Fax Number	:	360-734-5620

Provider Business Practice Location Address
First Line	:	3031 ORLEANS ST
Second Line	:	SUITE 103
City	:	BELLINGHAM
State	:	WA
Zip	:	98226-3541
Country	:	US
Telephone Number	:	360-734-3011
Fax Number	:	360-734-5620

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHOONG H. LEE
Credential	:	D.M.D.
Telephone Number	:	360-734-3011

Provider Enumeration Date	:	12/07/2006
Last Update Date	:	08/20/2008

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