Provider Demographics
NPI:1760585038
Name:LEE, ALLEN T (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:T
Last Name:LEE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 N SAN MATEO DR # B
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2418
Mailing Address - Country:US
Mailing Address - Phone:650-342-8874
Mailing Address - Fax:650-458-6391
Practice Address - Street 1:406 N SAN MATEO DR # B
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2418
Practice Address - Country:US
Practice Address - Phone:650-342-8874
Practice Address - Fax:650-458-6391
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA519641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA51964OtherDENTAL LICENSE