Provider Demographics
NPI:1285645432
Name:LEE, JETSON SCOTT (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:JETSON
Middle Name:SCOTT
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 20TH AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-2221
Mailing Address - Country:US
Mailing Address - Phone:415-752-8330
Mailing Address - Fax:415-752-8333
Practice Address - Street 1:380 20TH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-2221
Practice Address - Country:US
Practice Address - Phone:415-752-8330
Practice Address - Fax:415-752-8333
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0328701223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics