Provider Demographics
NPI:1710295407
Name:LEE GHORBANIAN I LTD
Entity Type:Organization
Organization Name:LEE GHORBANIAN I LTD
Other - Org Name:SUNRISE DENTAL OF CLACKAMAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-644-1126
Mailing Address - Street 1:12100 SE STEVENS CT
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97086-4707
Mailing Address - Country:US
Mailing Address - Phone:503-644-1126
Mailing Address - Fax:503-644-0692
Practice Address - Street 1:12100 SE STEVENS CT
Practice Address - Street 2:SUITE 102
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97086-4707
Practice Address - Country:US
Practice Address - Phone:503-644-1126
Practice Address - Fax:503-644-0692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty