Provider Demographics
NPI:1932290863
Name:LEE, GARY WILLIAM DOO (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:WILLIAM DOO
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 1:1805 OAK VIEW LN
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-1621
Mailing Address - Country:US
Mailing Address - Phone:626-592-3615
Mailing Address - Fax:
Practice Address - Street 1:1414 S GRAND AVE STE 485
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3076
Practice Address - Country:US
Practice Address - Phone:213-744-1752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADG307311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADG30731OtherDENTAL LICENSE