Provider Demographics
NPI:1184787178
Name:LEE, DANIEL (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
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 1:17895 N.W. EVERGREEN PARKWAY #150
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-7325
Mailing Address - Country:US
Mailing Address - Phone:503-533-9868
Mailing Address - Fax:503-533-9508
Practice Address - Street 1:17895 N.W. EVERGREEN PARKWAY #150
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-7325
Practice Address - Country:US
Practice Address - Phone:503-533-9868
Practice Address - Fax:503-533-9508
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA714141223G0001X
WADE000108251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice