Provider Demographics
NPI:1467432674
Name:LEE, MICHAEL J (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:LEE
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14535 S BASCOM AVE
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2003
Mailing Address - Country:US
Mailing Address - Phone:408-402-0100
Mailing Address - Fax:408-402-0111
Practice Address - Street 1:14535 S BASCOM AVE
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2003
Practice Address - Country:US
Practice Address - Phone:408-402-0100
Practice Address - Fax:408-402-0111
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA545101223P0700X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No1223G0001XDental ProvidersDentistGeneral Practice