Provider Demographics
NPI:1477070928
Name:LEE, DAVID D (DMD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:D
Last Name:LEE
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1174 N VOYAGER LN
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-1795
Mailing Address - Country:US
Mailing Address - Phone:562-667-6593
Mailing Address - Fax:
Practice Address - Street 1:1928 HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-4874
Practice Address - Country:US
Practice Address - Phone:626-441-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-25
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33965122300000X
CA108621122300000X
OK7001122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist