Provider Demographics
NPI:1669670113
Name:LEE, JONATHAN D (DDS)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:D
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 MARIN ST
Mailing Address - Street 2:SUITE 260
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-4236
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:555 MARIN ST
Practice Address - Street 2:SUITE 260
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-4236
Practice Address - Country:US
Practice Address - Phone:805-370-0110
Practice Address - Fax:805-370-3711
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA499241223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics