Provider Demographics
NPI:1194193680
Name:GARRETT A. LEE DDS, INC.
Entity Type:Organization
Organization Name:GARRETT A. LEE DDS, INC.
Other - Org Name:DR. GARRETT PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARRETT
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-783-7174
Mailing Address - Street 1:8241 BRUCEVILLE RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2365
Mailing Address - Country:US
Mailing Address - Phone:808-783-7174
Mailing Address - Fax:
Practice Address - Street 1:8241 BRUCEVILLE RD
Practice Address - Street 2:SUITE 180
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2365
Practice Address - Country:US
Practice Address - Phone:808-783-7174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA599551223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty