Provider Demographics
NPI:1245612423
Name:CHRIS J. LEE, DMD, CHRIS J. PARK, DDS, PLLC
Entity Type:Organization
Organization Name:CHRIS J. LEE, DMD, CHRIS J. PARK, DDS, PLLC
Other - Org Name:MILESTONE DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JIN
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-245-3349
Mailing Address - Street 1:10610 NE 9TH PL UNIT 1103
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-8640
Mailing Address - Country:US
Mailing Address - Phone:206-245-3349
Mailing Address - Fax:
Practice Address - Street 1:16330 SE 256TH ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-4233
Practice Address - Country:US
Practice Address - Phone:206-245-3349
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-24
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60229142261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental