Provider Demographics
NPI:1457760746
Name:LEE FAMILY DENTISTRY
Entity Type:Organization
Organization Name:LEE FAMILY DENTISTRY
Other - Org Name:DR. JASON M.STEVENS, D.M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:MICHEAL
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-445-1081
Mailing Address - Street 1:2176 MACLAND RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157-5190
Mailing Address - Country:US
Mailing Address - Phone:770-445-1081
Mailing Address - Fax:770-445-7737
Practice Address - Street 1:2176 MACLAND RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-5190
Practice Address - Country:US
Practice Address - Phone:770-445-1081
Practice Address - Fax:770-445-7737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN012439122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty