Provider Demographics
NPI:1801224662
Name:LEE, CHRISTINE ELIZABETH (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:ELIZABETH
Last Name:LEE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E PONCE DE LEON AVE
Mailing Address - Street 2:#300
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3466
Mailing Address - Country:US
Mailing Address - Phone:678-836-2113
Mailing Address - Fax:
Practice Address - Street 1:200 E PONCE DE LEON AVE
Practice Address - Street 2:#300
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3466
Practice Address - Country:US
Practice Address - Phone:678-836-2113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-14
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014690122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist