Provider Demographics
NPI:1477848430
Name:LEE, JONG HOON (DDS)
Entity Type:Individual
Prefix:
First Name:JONG
Middle Name:HOON
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:JONGHOON
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:12450 CLEVELAND RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-8353
Mailing Address - Country:US
Mailing Address - Phone:919-863-9763
Mailing Address - Fax:919-863-9767
Practice Address - Street 1:2617 S HORNER BLVD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27332-8032
Practice Address - Country:US
Practice Address - Phone:919-774-1993
Practice Address - Fax:919-774-0580
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC91601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice