Provider Demographics
NPI:1689289381
Name:LEE, JONGWOOK (DDS)
Entity Type:Individual
Prefix:DR
First Name:JONGWOOK
Middle Name:
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 1:2109 SAWDUST RD APT 24102
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-5705
Mailing Address - Country:US
Mailing Address - Phone:917-407-7468
Mailing Address - Fax:
Practice Address - Street 1:19380 INTERSTATE 45 STE 110
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77373-5308
Practice Address - Country:US
Practice Address - Phone:832-607-0404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36701122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist