Provider Demographics
NPI:1326280934
Name:CLARENCE LEE DDS INC.
Entity Type:Organization
Organization Name:CLARENCE LEE DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-696-4049
Mailing Address - Street 1:85-876 FARRINGTON HWY STE 202
Mailing Address - Street 2:
Mailing Address - City:WAIANAE
Mailing Address - State:HI
Mailing Address - Zip Code:96792-2498
Mailing Address - Country:US
Mailing Address - Phone:808-696-4049
Mailing Address - Fax:
Practice Address - Street 1:85-876 FARRINGTON HWY STE 202
Practice Address - Street 2:
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792-2498
Practice Address - Country:US
Practice Address - Phone:808-696-4049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLARENCE LEE DDS INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-1762261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental