Provider Demographics
NPI:1396803623
Name:LEE, JOSEPH (DDS)
Entity type:Individual
Prefix:
First Name:JOSEPH
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 1:6692 BORGES ST
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-8988
Mailing Address - Country:US
Mailing Address - Phone:714-381-1364
Mailing Address - Fax:
Practice Address - Street 1:9491 FOOTHILL BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3570
Practice Address - Country:US
Practice Address - Phone:909-962-7722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA527481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice