Provider Demographics
NPI:1356546758
Name:LEE, WAYNE W (DDS)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:W
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6100 GEARY BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-1910
Mailing Address - Country:US
Mailing Address - Phone:415-386-0790
Mailing Address - Fax:415-386-0792
Practice Address - Street 1:6100 GEARY BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-1910
Practice Address - Country:US
Practice Address - Phone:415-386-0790
Practice Address - Fax:415-386-0792
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA464891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice