Provider Demographics
NPI:1225362650
Name:LEE, DANIEL T (DDS)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:T
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 OCONNOR DR
Mailing Address - Street 2:STE 320
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1644
Mailing Address - Country:US
Mailing Address - Phone:510-465-5555
Mailing Address - Fax:510-465-5542
Practice Address - Street 1:455 OCONNOR DR STE 320
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1644
Practice Address - Country:US
Practice Address - Phone:408-971-9600
Practice Address - Fax:408-971-9616
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA548361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice