Provider Demographics
NPI:1700078284
Name:PATRICK W LEE DENTAL CORPORATION
Entity Type:Organization
Organization Name:PATRICK W LEE DENTAL CORPORATION
Other - Org Name:ABC KID'S DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:W
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-833-7888
Mailing Address - Street 1:2500 ALTON PKWY
Mailing Address - Street 2:SUITE 206
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-5024
Mailing Address - Country:US
Mailing Address - Phone:949-833-7888
Mailing Address - Fax:949-833-7887
Practice Address - Street 1:2500 ALTON PKWY
Practice Address - Street 2:SUITE 206
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-5024
Practice Address - Country:US
Practice Address - Phone:949-833-7888
Practice Address - Fax:949-833-7887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA460941223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty