Provider Demographics
NPI:1922507607
Name:VANCOUVER JOHN J LEE DDS,PC
Entity Type:Organization
Organization Name:VANCOUVER JOHN J LEE DDS,PC
Other - Org Name:EMERGENCY DENTIST VANCOUVER INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-546-1106
Mailing Address - Street 1:7819 NE 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-9601
Mailing Address - Country:US
Mailing Address - Phone:360-546-1106
Mailing Address - Fax:
Practice Address - Street 1:7819 NE 13TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-9601
Practice Address - Country:US
Practice Address - Phone:360-546-1106
Practice Address - Fax:360-546-0782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental