Provider Demographics
NPI:1083959209
Name:DEANNA L. LEE DMD, LLC
Entity Type:Organization
Organization Name:DEANNA L. LEE DMD, LLC
Other - Org Name:HAPPY SMILES FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:LAN
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-255-9733
Mailing Address - Street 1:11619 NE GLISAN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-2262
Mailing Address - Country:US
Mailing Address - Phone:503-255-9733
Mailing Address - Fax:503-894-8517
Practice Address - Street 1:11619 NE GLISAN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-2262
Practice Address - Country:US
Practice Address - Phone:503-255-9733
Practice Address - Fax:503-894-8517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD8988122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty