Provider Demographics
NPI:1134760408
Name:LEE, CHRISTIANA (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTIANA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:CHRISTIANA
Other - Middle Name:
Other - Last Name:CHENG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:391 S STATE COLLEGE BLVD STE M
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-5755
Mailing Address - Country:US
Mailing Address - Phone:147-464-8367
Mailing Address - Fax:
Practice Address - Street 1:391 S STATE COLLEGE BLVD STE M
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-5755
Practice Address - Country:US
Practice Address - Phone:714-464-8367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-08
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105075122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist