Provider Demographics
NPI:1770897829
Name:LEE, ROBERT JUN (DDS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:JUN
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14306 214TH PL SE
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98296-6823
Mailing Address - Country:US
Mailing Address - Phone:425-244-2322
Mailing Address - Fax:
Practice Address - Street 1:920 MOUNTAIN LOOP HWY
Practice Address - Street 2:
Practice Address - City:DARRINGTON
Practice Address - State:WA
Practice Address - Zip Code:98241-7740
Practice Address - Country:US
Practice Address - Phone:360-436-1008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25844122300000X
WADE60221116122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist