Provider Demographics
NPI:1114118601
Name:LEE, JUNG (DDS)
Entity Type:Individual
Prefix:
First Name:JUNG
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2651 TEXAS DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-7016
Mailing Address - Country:US
Mailing Address - Phone:972-255-4164
Mailing Address - Fax:801-226-4754
Practice Address - Street 1:2651 TEXAS DR
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-7016
Practice Address - Country:US
Practice Address - Phone:972-255-4164
Practice Address - Fax:972-252-1580
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00251591223G0001X
UT66051921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice