Provider Demographics
NPI:1689951865
Name:LEE ZHAO DMD PC
Entity Type:Organization
Organization Name:LEE ZHAO DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HONGLI
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHAO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-242-0021
Mailing Address - Street 1:2055 BEAVER RUIN RD STE E
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-3786
Mailing Address - Country:US
Mailing Address - Phone:770-242-0021
Mailing Address - Fax:770-242-6016
Practice Address - Street 1:2055 BEAVER RUIN RD STE E
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-3786
Practice Address - Country:US
Practice Address - Phone:770-242-0021
Practice Address - Fax:770-242-6016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013591122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty