Provider Demographics
NPI:1952823288
Name:PLUNKETT, LEE WOODROW (DMD)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:WOODROW
Last Name:PLUNKETT
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 1:8340 KENNINGSTON WAY
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-1667
Mailing Address - Country:US
Mailing Address - Phone:678-860-1931
Mailing Address - Fax:
Practice Address - Street 1:4675 N SHALLOWFORD RD STE 118
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-6309
Practice Address - Country:US
Practice Address - Phone:770-452-0222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-07
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN008445122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist