Provider Demographics
NPI:1689352452
Name:JOSHUA LEE DDS DENTAL CORPORATION
Entity Type:Organization
Organization Name:JOSHUA LEE DDS DENTAL CORPORATION
Other - Org Name:JOSHUA DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-385-0451
Mailing Address - Street 1:2454 OSWEGO ST UNIT 104
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-6339
Mailing Address - Country:US
Mailing Address - Phone:917-385-0451
Mailing Address - Fax:
Practice Address - Street 1:777 S ARROYO PKWY STE 104
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3908
Practice Address - Country:US
Practice Address - Phone:626-243-7999
Practice Address - Fax:626-243-7988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-10
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty