Provider Demographics
NPI:1497704563
Name:LEE, JOON H (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOON
Middle Name:H
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 CANTON RD
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2303
Mailing Address - Country:US
Mailing Address - Phone:770-889-0061
Mailing Address - Fax:770-887-3662
Practice Address - Street 1:205 CANTON RD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2303
Practice Address - Country:US
Practice Address - Phone:770-889-0061
Practice Address - Fax:770-887-3662
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA119221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA282422432AMedicaid