Provider Demographics
NPI:1649550294
Name:LEE, HEATHER SANGEUN (DDS)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:SANGEUN
Last Name:LEE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1322 W COVE RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28716-7112
Mailing Address - Country:US
Mailing Address - Phone:828-456-3911
Mailing Address - Fax:828-456-9714
Practice Address - Street 1:388 S MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-6409
Practice Address - Country:US
Practice Address - Phone:828-456-3911
Practice Address - Fax:828-456-9714
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-26
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC92191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice