Provider Demographics
NPI:1821202375
Name:LEE, JAMES L (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:L
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20475 VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-2729
Mailing Address - Country:US
Mailing Address - Phone:909-594-1801
Mailing Address - Fax:909-594-1803
Practice Address - Street 1:20475 VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-2729
Practice Address - Country:US
Practice Address - Phone:909-594-1801
Practice Address - Fax:909-594-1803
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA276421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice