Provider Demographics
NPI:1891806444
Name:LEE, BEOM J (DDS)
Entity Type:Individual
Prefix:MR
First Name:BEOM
Middle Name:J
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4855 RIVER GREEN PKWY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-8336
Mailing Address - Country:US
Mailing Address - Phone:770-500-3757
Mailing Address - Fax:770-476-4995
Practice Address - Street 1:4855 RIVER GREEN PKWY
Practice Address - Street 2:SUITE 110
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-8336
Practice Address - Country:US
Practice Address - Phone:770-500-3757
Practice Address - Fax:770-476-4995
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0133931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice