Provider Demographics
NPI:1881923423
Name:LEE, JOHNATHON M (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHNATHON
Middle Name:M
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 1:3150 COLIMA RD STE A
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-6356
Mailing Address - Country:US
Mailing Address - Phone:626-369-9494
Mailing Address - Fax:
Practice Address - Street 1:3150 COLIMA RD STE A
Practice Address - Street 2:
Practice Address - City:HACIENDA HTS
Practice Address - State:CA
Practice Address - Zip Code:91745-6356
Practice Address - Country:US
Practice Address - Phone:626-369-9494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51354122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist