Provider Demographics
NPI:1821578758
Name:LEE, MI SOOK (DMD, PHD)
Entity Type:Individual
Prefix:DR
First Name:MI SOOK
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:DMD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100426, 1395 CENTER DRIVE ROOM 11-6
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0426
Mailing Address - Country:US
Mailing Address - Phone:352-273-7643
Mailing Address - Fax:352-273-6765
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-0426
Practice Address - Country:US
Practice Address - Phone:352-273-7643
Practice Address - Fax:352-273-6765
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDTP8021223P0221X, 1223P0221X
CA1024941223G0001X, 1223P0221X
NE78661223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice