Provider Demographics
NPI:1952631814
Name:LEE, ALEXANDER (DMD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N COLLEGE PARK DR
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-8883
Mailing Address - Country:US
Mailing Address - Phone:916-601-7167
Mailing Address - Fax:
Practice Address - Street 1:795 E 2ND ST
Practice Address - Street 2:SUITE 8
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-2020
Practice Address - Country:US
Practice Address - Phone:909-469-8652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-28
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58746122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist