Provider Demographics
NPI:1750505202
Name:CHILDREN'S DENTAL SURGERY CENTER, A DENTAL PRACTICE OF DRS. LEE AND MU
Entity Type:Organization
Organization Name:CHILDREN'S DENTAL SURGERY CENTER, A DENTAL PRACTICE OF DRS. LEE AND MU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:714-432-7337
Mailing Address - Street 1:1610 W EDINGER AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-4339
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1610 W EDINGER AVE
Practice Address - Street 2:SUITE C
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-4339
Practice Address - Country:US
Practice Address - Phone:714-432-7337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA448071223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty