Provider Demographics
NPI:1811768245
Name:LEE, DAVIS MIN (DMD)
Entity type:Individual
Prefix:DR
First Name:DAVIS
Middle Name:MIN
Last Name:LEE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41871 MONTALLEGRO ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-2987
Mailing Address - Country:US
Mailing Address - Phone:661-917-1306
Mailing Address - Fax:
Practice Address - Street 1:1629 W AVENUE J STE 103
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2850
Practice Address - Country:US
Practice Address - Phone:661-948-7722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1096241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty