Provider Demographics
NPI:1053455501
Name:DANNY LEE, D.M.D A PROFESSIONAL CORP
Entity Type:Organization
Organization Name:DANNY LEE, D.M.D A PROFESSIONAL CORP
Other - Org Name:DENTAL SPA OF WEST COVINA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANNIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-859-2439
Mailing Address - Street 1:346 N AZUSA AVE
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-1345
Mailing Address - Country:US
Mailing Address - Phone:626-859-2439
Mailing Address - Fax:626-967-2351
Practice Address - Street 1:346 N AZUSA AVE
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91791-1345
Practice Address - Country:US
Practice Address - Phone:626-859-2439
Practice Address - Fax:626-967-2351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA471141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty