Provider Demographics
NPI:1164494522
Name:LEE, DONNA YEON (DMD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:YEON
Last Name:LEE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 ROSEWOOD LN N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441
Mailing Address - Country:US
Mailing Address - Phone:763-557-6016
Mailing Address - Fax:
Practice Address - Street 1:8500 42ND AVE N
Practice Address - Street 2:HERITAGE DENTAL
Practice Address - City:NEW HOPE
Practice Address - State:MN
Practice Address - Zip Code:55427
Practice Address - Country:US
Practice Address - Phone:763-537-6070
Practice Address - Fax:763-537-6076
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11416122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist