Provider Demographics
NPI:1437456712
Name:GRACE H LEE DDS LTD
Entity Type:Organization
Organization Name:GRACE H LEE DDS LTD
Other - Org Name:LAKEVIEW SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:H
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-929-1150
Mailing Address - Street 1:916 W BELMONT AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4427
Mailing Address - Country:US
Mailing Address - Phone:773-929-1150
Mailing Address - Fax:773-929-0831
Practice Address - Street 1:916 W BELMONT AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-4427
Practice Address - Country:US
Practice Address - Phone:773-929-1150
Practice Address - Fax:773-929-0831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.026497261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental