Provider Demographics
NPI:1750399747
Name:LEE UN A PROFESSIONAL DENTAL CORP
Entity type:Organization
Organization Name:LEE UN A PROFESSIONAL DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:UN
Authorized Official - Middle Name:T
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-325-7158
Mailing Address - Street 1:471 E TAHQUITZ CYN WAY #221
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92264
Mailing Address - Country:US
Mailing Address - Phone:760-325-7158
Mailing Address - Fax:760-327-7657
Practice Address - Street 1:471 E TAHQUITZ CYN WAY #221
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92264
Practice Address - Country:US
Practice Address - Phone:760-325-7158
Practice Address - Fax:760-327-7657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty