Provider Demographics
NPI:1497830913
Name:LEE, JAMES S (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:S
Last Name:LEE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2996 S NORFOLK ST STE E
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-2076
Mailing Address - Country:US
Mailing Address - Phone:650-349-0111
Mailing Address - Fax:650-349-0133
Practice Address - Street 1:2996 S NORFOLK ST STE E
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-2076
Practice Address - Country:US
Practice Address - Phone:650-349-0111
Practice Address - Fax:650-349-0133
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0371271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice