Provider Demographics
NPI:1164417267
Name:LEE, JOHN S (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
Last Name:LEE
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S DENTON TAP RD STE 200
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-4539
Mailing Address - Country:US
Mailing Address - Phone:972-471-0647
Mailing Address - Fax:
Practice Address - Street 1:600 S DENTON TAP RD STE 200
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4539
Practice Address - Country:US
Practice Address - Phone:972-471-0647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010194361223G0001X
NJ22DI022644001223G0001X
PADS0358511223G0001X
TX237771223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice