Provider Demographics
NPI:1235852054
Name:LEE, KATHERINE MARY (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:MARY
Last Name:LEE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8201 EDGEWATER DR STE 106
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94621-2021
Mailing Address - Country:US
Mailing Address - Phone:510-568-3577
Mailing Address - Fax:510-568-8178
Practice Address - Street 1:8201 EDGEWATER DR STE 106
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94621-2021
Practice Address - Country:US
Practice Address - Phone:510-568-3577
Practice Address - Fax:510-568-8178
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1081031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice