Provider Demographics
NPI:1275896953
Name:RICHARD LEE DDS PC
Entity Type:Organization
Organization Name:RICHARD LEE DDS PC
Other - Org Name:IDENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-830-0123
Mailing Address - Street 1:1298 KIFER RD
Mailing Address - Street 2:#501
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94086
Mailing Address - Country:US
Mailing Address - Phone:408-830-0123
Mailing Address - Fax:408-830-0178
Practice Address - Street 1:1298 KIFER RD
Practice Address - Street 2:#501
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94086
Practice Address - Country:US
Practice Address - Phone:408-830-0123
Practice Address - Fax:408-830-0178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55731122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty