Provider Demographics
NPI:1417973058
Name:DAVID S. LEE, DDS., INC., DBA MODERN DENTAL
Entity Type:Organization
Organization Name:DAVID S. LEE, DDS., INC., DBA MODERN DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:SHIHYUNG
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-571-0251
Mailing Address - Street 1:801 E VALLEY BLVD
Mailing Address - Street 2:#205
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-3697
Mailing Address - Country:US
Mailing Address - Phone:626-571-0251
Mailing Address - Fax:626-571-0425
Practice Address - Street 1:801 E VALLEY BLVD
Practice Address - Street 2:#205
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3697
Practice Address - Country:US
Practice Address - Phone:626-571-0251
Practice Address - Fax:626-571-0425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA484941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty