Provider Demographics
NPI:1346770500
Name:LEE, HYEOK JE (DMD)
Entity Type:Individual
Prefix:DR
First Name:HYEOK
Middle Name:JE
Last Name:LEE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6240 QUINWOOD LN N # 100
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-6384
Mailing Address - Country:US
Mailing Address - Phone:763-391-6486
Mailing Address - Fax:763-710-7485
Practice Address - Street 1:6240 QUINWOOD LN N # 100
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-6384
Practice Address - Country:US
Practice Address - Phone:763-391-6486
Practice Address - Fax:763-710-7485
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND138771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice