Provider Demographics
NPI:1851388821
Name:LEE, DAVID PETER (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PETER
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 1:1867 JONESBORO RD STE 12
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-6099
Mailing Address - Country:US
Mailing Address - Phone:770-222-2322
Mailing Address - Fax:
Practice Address - Street 1:1867 JONESBORO RD STE 12
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-6099
Practice Address - Country:US
Practice Address - Phone:770-222-2322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN239021223X0400X
PADS030279L1223X0400X
GADN0156211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics