Provider Demographics
NPI:1497912281
Name:LEE, SEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:
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 1:4016 UNIVERSITY PKWY
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92407-1821
Mailing Address - Country:US
Mailing Address - Phone:909-880-1600
Mailing Address - Fax:909-880-1633
Practice Address - Street 1:4016 UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92407-1821
Practice Address - Country:US
Practice Address - Phone:909-880-1600
Practice Address - Fax:909-880-1633
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA362591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice