Provider Demographics
NPI:1609580232
Name:LEE, SO Y (RDH)
Entity Type:Individual
Prefix:
First Name:SO
Middle Name:Y
Last Name:LEE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 WHEYLON CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-8853
Mailing Address - Country:US
Mailing Address - Phone:404-667-3498
Mailing Address - Fax:
Practice Address - Street 1:2005 BOGGS RD # 104-107
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-4601
Practice Address - Country:US
Practice Address - Phone:770-497-0885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist