Provider Demographics
NPI:1932672656
Name:NOMI LEE DENTAL GROUP INC
Entity Type:Organization
Organization Name:NOMI LEE DENTAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NOMI
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-825-3210
Mailing Address - Street 1:1636 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-4605
Mailing Address - Country:US
Mailing Address - Phone:909-825-3210
Mailing Address - Fax:909-512-6897
Practice Address - Street 1:1636 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-4605
Practice Address - Country:US
Practice Address - Phone:909-825-3210
Practice Address - Fax:909-512-6897
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NOMI LEE DENTAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental