Provider Demographics
NPI:1831370873
Name:LEE, CHERYL (DDS)
Entity type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12302 GARDEN GROVE BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1833
Mailing Address - Country:US
Mailing Address - Phone:714-534-9292
Mailing Address - Fax:
Practice Address - Street 1:12302 GARDEN GROVE BLVD STE 1
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1833
Practice Address - Country:US
Practice Address - Phone:714-534-9292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA352871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice