Provider Demographics
NPI:1073743944
Name:LEE, TERESA J (DD,S)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:J
Last Name:LEE
Suffix:
Gender:F
Credentials:DD,S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3351 M ST STE 115
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-2732
Mailing Address - Country:US
Mailing Address - Phone:209-383-7804
Mailing Address - Fax:209-383-9154
Practice Address - Street 1:3351 M ST STE 115
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-2732
Practice Address - Country:US
Practice Address - Phone:209-383-7804
Practice Address - Fax:209-383-9154
Is Sole Proprietor?:No
Enumeration Date:2009-07-24
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA562711223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry