Provider Demographics
NPI:1851884886
Name:SHAUNA R. LEE, DDS DENTAL CORPORATION
Entity Type:Organization
Organization Name:SHAUNA R. LEE, DDS DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAUNA
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-269-8007
Mailing Address - Street 1:4146 E OLYMPIC BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90023-3347
Mailing Address - Country:US
Mailing Address - Phone:323-269-8007
Mailing Address - Fax:323-269-2720
Practice Address - Street 1:4146 E OLYMPIC BLVD STE F
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90023-3347
Practice Address - Country:US
Practice Address - Phone:323-269-8007
Practice Address - Fax:323-269-2720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39030261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental