Provider Demographics
NPI:1699843052
Name:LEE, LISA KOH (DMD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:KOH
Last Name:LEE
Suffix:
Gender:F
Credentials:DMD
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Mailing Address - Street 1:1299 OLD PEACHTREE RD NW
Mailing Address - Street 2:SUITE 102, 103
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-2028
Mailing Address - Country:US
Mailing Address - Phone:770-813-9393
Mailing Address - Fax:770-813-9351
Practice Address - Street 1:1299 OLD PEACHTREE RD NW
Practice Address - Street 2:SUITE 102, 103
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-2028
Practice Address - Country:US
Practice Address - Phone:770-813-9393
Practice Address - Fax:770-813-9351
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GADN0129771223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry