Provider Demographics
NPI:1043397805
Name:LEE, DANIEL JIN (DMD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JIN
Last Name:LEE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 SAINT MARLO COUNTRY CLUB PKWY
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-1625
Mailing Address - Country:US
Mailing Address - Phone:770-454-8432
Mailing Address - Fax:678-990-9799
Practice Address - Street 1:4569 DALLAS STREET
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101
Practice Address - Country:US
Practice Address - Phone:770-974-4146
Practice Address - Fax:770-974-4146
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013434122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist