Provider Demographics
NPI:1912124868
Name:SCHALLER, LEE W (DMD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:W
Last Name:SCHALLER
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 1:378 PERKINS ST
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-6827
Mailing Address - Country:US
Mailing Address - Phone:707-996-4519
Mailing Address - Fax:707-996-1707
Practice Address - Street 1:378 PERKINS ST
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-6827
Practice Address - Country:US
Practice Address - Phone:707-996-4519
Practice Address - Fax:707-996-1707
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA193001223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology