Provider Demographics
NPI:1750025664
Name:LEE, SAMANTHA NICOLE
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:NICOLE
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 CALIFORNIA ST STE 202
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1743
Mailing Address - Country:US
Mailing Address - Phone:415-751-1700
Mailing Address - Fax:415-751-1743
Practice Address - Street 1:3501 CALIFORNIA ST STE 202
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1743
Practice Address - Country:US
Practice Address - Phone:415-751-1700
Practice Address - Fax:415-751-1743
Is Sole Proprietor?:No
Enumeration Date:2022-04-26
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1046401223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics