Provider Demographics
NPI:1225137045
Name:SUSAN H LEE DMD LLC
Entity Type:Organization
Organization Name:SUSAN H LEE DMD LLC
Other - Org Name:CHILDREN'S DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:HAE-KYUNG
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:404-355-8557
Mailing Address - Street 1:3280 HOWELL MILL RD NW
Mailing Address - Street 2:STE 121
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-4111
Mailing Address - Country:US
Mailing Address - Phone:404-355-8557
Mailing Address - Fax:
Practice Address - Street 1:3280 HOWELL MILL RD NW
Practice Address - Street 2:STE 121
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-4111
Practice Address - Country:US
Practice Address - Phone:404-355-8557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0118721223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000821895EMedicaid