Provider Demographics
NPI:1346364700
Name:SHIRLEY T. LEE DDS INC
Entity Type:Organization
Organization Name:SHIRLEY T. LEE DDS INC
Other - Org Name:FULLERTON FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:T
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-871-3900
Mailing Address - Street 1:906 W ORANGETHORPE AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-2827
Mailing Address - Country:US
Mailing Address - Phone:714-871-3900
Mailing Address - Fax:714-870-1127
Practice Address - Street 1:906 W ORANGETHORPE AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-2827
Practice Address - Country:US
Practice Address - Phone:714-871-3900
Practice Address - Fax:714-870-1127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA460961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty