Provider Demographics
NPI:1023294683
Name:J. GINA LEE, DDS, MDS, PA
Entity type:Organization
Organization Name:J. GINA LEE, DDS, MDS, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:J. GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MDS
Authorized Official - Phone:919-544-9700
Mailing Address - Street 1:10411 MONCREIFFE RD
Mailing Address - Street 2:SUITE 105A
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-7819
Mailing Address - Country:US
Mailing Address - Phone:919-544-9700
Mailing Address - Fax:919-544-9002
Practice Address - Street 1:10411 MONCREIFFE RD
Practice Address - Street 2:SUITE 105A
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-7819
Practice Address - Country:US
Practice Address - Phone:919-544-9700
Practice Address - Fax:919-544-9002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8083261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center