Provider Demographics
NPI:1467690636
Name:LEE, ERINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERINA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 CAMINO DE LA REINA
Mailing Address - Street 2:#117
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-5522
Mailing Address - Country:US
Mailing Address - Phone:909-556-9850
Mailing Address - Fax:619-269-7176
Practice Address - Street 1:2020 CAMINO DE LA REINA
Practice Address - Street 2:#117
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-5522
Practice Address - Country:US
Practice Address - Phone:909-556-9850
Practice Address - Fax:619-269-7176
Is Sole Proprietor?:No
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA570631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice