Provider Demographics
NPI:1073788576
Name:LEE, FRED C (DDS)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:C
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20262 BILLINGSGATE LN
Mailing Address - Street 2:UNIT 202
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-8548
Mailing Address - Country:US
Mailing Address - Phone:714-369-8970
Mailing Address - Fax:714-963-3550
Practice Address - Street 1:10111 ADAMS AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646
Practice Address - Country:US
Practice Address - Phone:714-963-3555
Practice Address - Fax:714-963-3550
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41638122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist