Provider Demographics
NPI:1952501256
Name:LEE, DONGWOOK BERNARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONGWOOK
Middle Name:BERNARD
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 1:8672 E PLACITA DE LAS TARASCAS # 2
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-6200
Mailing Address - Country:US
Mailing Address - Phone:909-890-6286
Mailing Address - Fax:
Practice Address - Street 1:9660 E 22ND ST
Practice Address - Street 2:#160
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85748
Practice Address - Country:US
Practice Address - Phone:520-917-0666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD7331122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist