Provider Demographics
NPI:1710923537
Name:LEE, JUNGWOO (DDS)
Entity Type:Individual
Prefix:DR
First Name:JUNGWOO
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 1:11210 OLBRICH TRL
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-2613
Mailing Address - Country:US
Mailing Address - Phone:480-646-6107
Mailing Address - Fax:
Practice Address - Street 1:11160 MEDLOCK BRIDGE RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-2641
Practice Address - Country:US
Practice Address - Phone:770-847-7690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010693122300000X
AZD0086791223G0001X
GADN123077122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200501900Medicaid