Provider Demographics
NPI:1356339337
Name:LEE, IGNATIUS K (DDS)
Entity type:Individual
Prefix:DR
First Name:IGNATIUS
Middle Name:K
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 1:14400 W BURNSVILLE PKWY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55306-4983
Mailing Address - Country:US
Mailing Address - Phone:952-736-1080
Mailing Address - Fax:
Practice Address - Street 1:14400 W BURNSVILLE PKWY
Practice Address - Street 2:SUITE 2
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55306-4983
Practice Address - Country:US
Practice Address - Phone:952-736-1080
Practice Address - Fax:952-736-1091
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9633122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN320223200Medicaid