Provider Demographics
NPI:1659955532
Name:JAE LEE DDS LLC
Entity Type:Organization
Organization Name:JAE LEE DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:813-765-2804
Mailing Address - Street 1:8010 MCGINNIS FERRY RD STE F
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-5137
Mailing Address - Country:US
Mailing Address - Phone:770-765-2815
Mailing Address - Fax:
Practice Address - Street 1:8010 MCGINNIS FERRY RD STE F
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-5137
Practice Address - Country:US
Practice Address - Phone:813-765-2804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-07
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty