Provider Demographics
NPI:1083775696
Name:LEE, SUSAN J (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:J
Last Name:LEE
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Gender:F
Credentials:DMD, MD
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Mailing Address - Street 1:18372 CLARK ST
Mailing Address - Street 2:SUITE 224
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3508
Mailing Address - Country:US
Mailing Address - Phone:818-996-1200
Mailing Address - Fax:818-996-1325
Practice Address - Street 1:18372 CLARK ST
Practice Address - Street 2:SUITE 224
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3508
Practice Address - Country:US
Practice Address - Phone:818-996-1200
Practice Address - Fax:818-996-1325
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CAA946711223S0112X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Not Answered204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery