Provider Demographics
NPI:1508901323
Name:LEE AND DUBANSKI DENTAL CORPORATION
Entity Type:Organization
Organization Name:LEE AND DUBANSKI DENTAL CORPORATION
Other - Org Name:ROCKLIN FAMILY DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:GERTRUDE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:916-315-3558
Mailing Address - Street 1:4750 ROCKLIN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-3334
Mailing Address - Country:US
Mailing Address - Phone:916-315-3558
Mailing Address - Fax:916-315-9301
Practice Address - Street 1:4750 ROCKLIN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-3334
Practice Address - Country:US
Practice Address - Phone:916-315-3558
Practice Address - Fax:916-315-9301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA356661223G0001X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty