Provider Demographics
NPI:1609389949
Name:D. HARVEY LEE DDS DENTAL CORPORATION, INC.
Entity Type:Organization
Organization Name:D. HARVEY LEE DDS DENTAL CORPORATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:HARVEY
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-885-9300
Mailing Address - Street 1:4840 IRVINE BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-1962
Mailing Address - Country:US
Mailing Address - Phone:949-885-9300
Mailing Address - Fax:
Practice Address - Street 1:4840 IRVINE BLVD STE 106
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620-1962
Practice Address - Country:US
Practice Address - Phone:949-885-9300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-08
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA568611223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty