Provider Demographics
NPI:1821474677
Name:LEE, GREG (DMD)
Entity Type:Individual
Prefix:DR
First Name:GREG
Middle Name:
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 1:515 NE 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4955
Mailing Address - Country:US
Mailing Address - Phone:541-382-0414
Mailing Address - Fax:541-382-9469
Practice Address - Street 1:515 NE 4TH ST
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4955
Practice Address - Country:US
Practice Address - Phone:541-382-0414
Practice Address - Fax:541-382-9469
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD103301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice