Provider Demographics
NPI:1811585565
Name:LEE, ELAINE CHRISTINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:CHRISTINA
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 1:5137 FAWN HOLLOW WAY
Mailing Address - Street 2:
Mailing Address - City:ANTELOPE
Mailing Address - State:CA
Mailing Address - Zip Code:95843-4643
Mailing Address - Country:US
Mailing Address - Phone:916-273-0887
Mailing Address - Fax:
Practice Address - Street 1:6024 SAN JUAN AVE STE C
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-5643
Practice Address - Country:US
Practice Address - Phone:916-728-2888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1051101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice