Provider Demographics
NPI:1851412803
Name:LEE, GINA J (DDS)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:J
Last Name:LEE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10805 ASHLAND MILL CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-7767
Mailing Address - Country:US
Mailing Address - Phone:919-806-3839
Mailing Address - Fax:
Practice Address - Street 1:10411 MONCREIFFE RD
Practice Address - Street 2:SUITE 105A
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-7819
Practice Address - Country:US
Practice Address - Phone:919-544-9700
Practice Address - Fax:919-544-9002
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC80831223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics