Provider Demographics
NPI:1225588585
Name:LEE, SAMUEL JUN (DDS)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:JUN
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 1:4649 LOMA DEL SUR DR APT 3210
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79934-3365
Mailing Address - Country:US
Mailing Address - Phone:217-316-3315
Mailing Address - Fax:
Practice Address - Street 1:21227 TORCH ST
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AA
Practice Address - Zip Code:79918
Practice Address - Country:US
Practice Address - Phone:915-742-4248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-11
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-09639122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist