Provider Demographics
NPI:1750305918
Name:LEE, MELINDA JENNIFER (DDS)
Entity Type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:JENNIFER
Last Name:LEE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37070 NEWARK BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-3798
Mailing Address - Country:US
Mailing Address - Phone:510-792-1346
Mailing Address - Fax:
Practice Address - Street 1:37070 NEWARK BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560-3798
Practice Address - Country:US
Practice Address - Phone:510-792-1346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA445671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice