Provider Demographics
NPI:1891751004
Name:LERBERG, LEE CORSON (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:CORSON
Last Name:LERBERG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4410 NATHAN LN N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55442-2586
Mailing Address - Country:US
Mailing Address - Phone:763-553-0311
Mailing Address - Fax:763-553-0304
Practice Address - Street 1:4410 NATHAN LN N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55442-2586
Practice Address - Country:US
Practice Address - Phone:763-553-0311
Practice Address - Fax:763-553-0304
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND75701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice