Provider Demographics
NPI:1023217114
Name:LEE, JENNIFER C (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:C
Last Name:LEE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18431 COLIMA RD
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-5815
Mailing Address - Country:US
Mailing Address - Phone:626-854-6060
Mailing Address - Fax:626-854-6062
Practice Address - Street 1:18431 COLIMA RD
Practice Address - Street 2:
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-5815
Practice Address - Country:US
Practice Address - Phone:626-854-6060
Practice Address - Fax:626-854-6060
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51963122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist