Provider Demographics
NPI:1619600731
Name:DANIEL LEE DDS INC
Entity Type:Organization
Organization Name:DANIEL LEE DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-883-6367
Mailing Address - Street 1:391 S. STATE COLLEGE BLVD.
Mailing Address - Street 2:SUITE #M
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821
Mailing Address - Country:US
Mailing Address - Phone:714-803-6367
Mailing Address - Fax:714-455-5742
Practice Address - Street 1:391 S. STATE COLLEGE BLVD.
Practice Address - Street 2:SUITE #M
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821
Practice Address - Country:US
Practice Address - Phone:714-803-6367
Practice Address - Fax:714-455-5742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty