Provider Demographics
NPI:1609885367
Name:LEE, JANICE R (DMD)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:R
Last Name:LEE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5503 PEACHTREE DUNWOODY RD
Mailing Address - Street 2:STE 470
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342
Mailing Address - Country:US
Mailing Address - Phone:404-255-5686
Mailing Address - Fax:404-255-9501
Practice Address - Street 1:5503 PEACHTREE DUNWOODY RD
Practice Address - Street 2:STE 470
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:404-255-5686
Practice Address - Fax:404-255-9501
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011523122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist