Provider Demographics
NPI:1922248798
Name:LEE, CANDY (DDS)
Entity Type:Individual
Prefix:DR
First Name:CANDY
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 MILLER AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-2759
Mailing Address - Country:US
Mailing Address - Phone:415-388-8400
Mailing Address - Fax:415-383-8615
Practice Address - Street 1:163 MILLER AVE STE 1
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-2759
Practice Address - Country:US
Practice Address - Phone:415-388-8400
Practice Address - Fax:415-383-8615
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA457271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice