Provider Demographics
NPI:1336457829
Name:LEE GHORBANIAN
Entity Type:Organization
Organization Name:LEE GHORBANIAN
Other - Org Name:SUNRISE DENTAL OF SALEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-644-1126
Mailing Address - Street 1:482 LANCASTER DR NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-4784
Mailing Address - Country:US
Mailing Address - Phone:503-644-1126
Mailing Address - Fax:503-644-0692
Practice Address - Street 1:482 LANCASTER DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4784
Practice Address - Country:US
Practice Address - Phone:503-644-1126
Practice Address - Fax:503-644-0692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD7463282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural