Provider Demographics
NPI:1285856427
Name:LEE, JOHN J (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:LEE
Suffix:
Gender:M
Credentials:DMD
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Mailing Address - Street 1:1790 ATKINSON RD
Mailing Address - Street 2:BLDG 4 STE G
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043
Mailing Address - Country:US
Mailing Address - Phone:678-226-2716
Mailing Address - Fax:678-226-2717
Practice Address - Street 1:2405 SATELLITE BLVD
Practice Address - Street 2:STE 115
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-5818
Practice Address - Country:US
Practice Address - Phone:678-226-2716
Practice Address - Fax:678-226-2717
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GADN1221901223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics