Provider Demographics
NPI:1184848764
Name:MICHAEL H. LEE, D.D.S., INC
Entity Type:Organization
Organization Name:MICHAEL H. LEE, D.D.S., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-924-3334
Mailing Address - Street 1:17334 PIONEER BLVD
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701-2708
Mailing Address - Country:US
Mailing Address - Phone:562-924-3334
Mailing Address - Fax:562-809-3007
Practice Address - Street 1:17334 PIONEER BLVD
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701-2708
Practice Address - Country:US
Practice Address - Phone:562-924-3334
Practice Address - Fax:562-809-3007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA277851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB27785OtherDENTI-CAL
CA=========OtherTAX IDENTIFICATION NUMBER