Provider Demographics
NPI:1386852119
Name:JAMESON, LEE MERLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:MERLE
Last Name:JAMESON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8119 WOODCREEK CT
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-4536
Mailing Address - Country:US
Mailing Address - Phone:630-985-9303
Mailing Address - Fax:
Practice Address - Street 1:7350 W COLLEGE DR
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1149
Practice Address - Country:US
Practice Address - Phone:708-448-7588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics