Provider Demographics
NPI:1043590482
Name:LEE, SHAUN M (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:M
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 EAST AVE # 5
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-1628
Mailing Address - Country:US
Mailing Address - Phone:530-433-9744
Mailing Address - Fax:530-965-5723
Practice Address - Street 1:1430 EAST AVE # 5
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1628
Practice Address - Country:US
Practice Address - Phone:530-965-5707
Practice Address - Fax:530-965-5723
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS60610122300000X
NMDD3544122300000X
CA606101223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMPENDINGMedicaid