Provider Demographics
NPI:1417002924
Name:LEE, STEPHEN AUSTIN (DO)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:AUSTIN
Last Name:LEE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13035 POMERADO RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-4247
Mailing Address - Country:US
Mailing Address - Phone:858-748-3384
Mailing Address - Fax:858-748-3456
Practice Address - Street 1:13035 POMERADO RD
Practice Address - Street 2:SUITE B
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-4247
Practice Address - Country:US
Practice Address - Phone:858-748-3384
Practice Address - Fax:858-748-3456
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA369611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice