Provider Demographics
NPI:1609068147
Name:LEE, RUSSELL HENRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:HENRY
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 1:3277 DRY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-9663
Mailing Address - Country:US
Mailing Address - Phone:707-328-0083
Mailing Address - Fax:707-226-6645
Practice Address - Street 1:3277 DRY CREEK RD
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-9663
Practice Address - Country:US
Practice Address - Phone:707-328-0083
Practice Address - Fax:707-226-6645
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20113122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist