Provider Demographics
NPI:1275316283
Name:DOAN DDS AND LEE DDS, A DENTAL CORPORATION
Entity Type:Organization
Organization Name:DOAN DDS AND LEE DDS, A DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFONSE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-888-6300
Mailing Address - Street 1:324 E 11TH ST STE E2
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-4084
Mailing Address - Country:US
Mailing Address - Phone:209-888-6300
Mailing Address - Fax:
Practice Address - Street 1:324 E 11TH ST STE E2
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-4084
Practice Address - Country:US
Practice Address - Phone:510-512-0356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-15
Last Update Date:2024-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty