Provider Demographics
NPI:1225430473
Name:RYAN S C LEE,A PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:RYAN S C LEE,A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:ATLANTIC PACIFIC SMILE DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:S C
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-261-9999
Mailing Address - Street 1:2111 S ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-6801
Mailing Address - Country:US
Mailing Address - Phone:323-261-9999
Mailing Address - Fax:323-260-7680
Practice Address - Street 1:2111 S ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-6801
Practice Address - Country:US
Practice Address - Phone:323-261-9999
Practice Address - Fax:323-260-7680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41594122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty