Provider Demographics
NPI:1477701563
Name:LEE, JENNIFER LISA (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LISA
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 1:324 N SAN MATEO DR
Mailing Address - Street 2:#2
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2514
Mailing Address - Country:US
Mailing Address - Phone:650-343-5555
Mailing Address - Fax:650-343-2225
Practice Address - Street 1:324 N SAN MATEO DR
Practice Address - Street 2:#2
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2514
Practice Address - Country:US
Practice Address - Phone:650-343-5555
Practice Address - Fax:650-343-2225
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57546122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist