Provider Demographics
NPI:1639738016
Name:LEE, ALEX CRISTOPHER (DMD)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:CRISTOPHER
Last Name:LEE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2707 W OLYMPIC BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2859
Mailing Address - Country:US
Mailing Address - Phone:213-399-4711
Mailing Address - Fax:
Practice Address - Street 1:2065 W 6TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-3158
Practice Address - Country:US
Practice Address - Phone:213-484-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103738122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist