Provider Demographics
NPI:1760856009
Name:LEE, BRIAN DALVIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:DALVIN
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1291 E HILLSDALE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-1220
Mailing Address - Country:US
Mailing Address - Phone:650-574-4447
Mailing Address - Fax:650-574-4041
Practice Address - Street 1:1291 E HILLSDALE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:FOSTER CITY
Practice Address - State:CA
Practice Address - Zip Code:94404-1220
Practice Address - Country:US
Practice Address - Phone:650-574-4447
Practice Address - Fax:650-574-4041
Is Sole Proprietor?:No
Enumeration Date:2015-11-24
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19108122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist