Provider Demographics
NPI:1598858094
Name:LEE, JOSEPH (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
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 1:112 SW 160TH ST
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-3025
Mailing Address - Country:US
Mailing Address - Phone:206-244-6774
Mailing Address - Fax:206-244-2204
Practice Address - Street 1:112 SW 160TH ST
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3025
Practice Address - Country:US
Practice Address - Phone:206-244-6774
Practice Address - Fax:206-244-2204
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22045122300000X
WADE000095631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist