Provider Demographics
NPI:1518302587
Name:DAVID LEE DDS, MS, INC
Entity Type:Organization
Organization Name:DAVID LEE DDS, MS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:714-222-4551
Mailing Address - Street 1:10212 WESTMINSTER AVE
Mailing Address - Street 2:SUITES 104-105
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-4800
Mailing Address - Country:US
Mailing Address - Phone:714-202-0222
Mailing Address - Fax:
Practice Address - Street 1:10212 WESTMINSTER AVE
Practice Address - Street 2:SUITES 104-105
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-4800
Practice Address - Country:US
Practice Address - Phone:714-202-0222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA560161223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty