Provider Demographics
NPI:1578766309
Name:LEE, RICHARD NORMAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:NORMAN
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 1:1041 PARKSIDE COMMONS
Mailing Address - Street 2:SUITE 104
Mailing Address - City:GREENSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30642
Mailing Address - Country:US
Mailing Address - Phone:706-454-0044
Mailing Address - Fax:706-454-0088
Practice Address - Street 1:1041 PARKSIDE COMMONS
Practice Address - Street 2:SUITE 104
Practice Address - City:GREENSBORO
Practice Address - State:GA
Practice Address - Zip Code:30642
Practice Address - Country:US
Practice Address - Phone:706-454-0044
Practice Address - Fax:706-454-0088
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice