Provider Demographics
NPI:1811928831
Name:JESSE G. LEE, D.D.S
Entity type:Organization
Organization Name:JESSE G. LEE, D.D.S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:G
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:910-892-2137
Mailing Address - Street 1:210 N ELLIS AVE
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334-3807
Mailing Address - Country:US
Mailing Address - Phone:910-892-2137
Mailing Address - Fax:910-892-2546
Practice Address - Street 1:210 N ELLIS AVE
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-3807
Practice Address - Country:US
Practice Address - Phone:910-892-2137
Practice Address - Fax:910-892-2546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8995206Medicaid
NC545899OtherTRICARE
NC95206OtherBCBS