Provider Demographics
NPI:1457495772
Name:LEE, DAVID SANGJOON (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SANGJOON
Last Name:LEE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 E DESERT INN RD STE 105
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-3871
Mailing Address - Country:US
Mailing Address - Phone:702-241-8206
Mailing Address - Fax:702-894-4175
Practice Address - Street 1:3050 E DESERT INN RD STE 105
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-3871
Practice Address - Country:US
Practice Address - Phone:702-241-8206
Practice Address - Fax:702-894-4175
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV35181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002202308Medicaid