Provider Demographics
NPI:1457339855
Name:LEE, JAE SEONG (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAE
Middle Name:SEONG
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 1:1000 VINO DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-3079
Mailing Address - Country:US
Mailing Address - Phone:919-388-7777
Mailing Address - Fax:919-388-7778
Practice Address - Street 1:1500 PINEY PLAINS RD STE 101
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-6898
Practice Address - Country:US
Practice Address - Phone:919-388-7777
Practice Address - Fax:919-388-7778
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC80021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice