Provider Demographics
NPI:1437358587
Name:HENRY H. LEE, DDS, GENERAL DENTISTRY
Entity Type:Organization
Organization Name:HENRY H. LEE, DDS, GENERAL DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:H
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-524-1836
Mailing Address - Street 1:17021 YORBA LINDA BLVD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-3743
Mailing Address - Country:US
Mailing Address - Phone:714-524-1836
Mailing Address - Fax:
Practice Address - Street 1:17021 YORBA LINDA BLVD
Practice Address - Street 2:SUITE 10
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-3743
Practice Address - Country:US
Practice Address - Phone:714-524-1836
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45134122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA45134OtherCALIFORNIA DENTAL BOARD
CAB45134-01OtherCALIFORNIA MEDI-CAL
CAD45134OtherCALIFORNIA MEDI-CAL