Provider Demographics
NPI:1922213305
Name:LEE, PATRICK HAMMILL (DDS)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:HAMMILL
Last Name:LEE
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 1:107 CALEDONIA STREET
Mailing Address - Street 2:SUITE I
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94965
Mailing Address - Country:US
Mailing Address - Phone:415-331-5656
Mailing Address - Fax:415-331-5614
Practice Address - Street 1:107 CALEDONIA STREET
Practice Address - Street 2:SUITE I
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965
Practice Address - Country:US
Practice Address - Phone:415-331-5656
Practice Address - Fax:415-331-5614
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34627122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist