Provider Demographics
NPI:1932248085
Name:DR JEFFREY LEE MD DMD
Entity Type:Organization
Organization Name:DR JEFFREY LEE MD DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD DMD
Authorized Official - Phone:714-734-9363
Mailing Address - Street 1:17452 IRVINE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3031
Mailing Address - Country:US
Mailing Address - Phone:714-734-9363
Mailing Address - Fax:714-734-9362
Practice Address - Street 1:17452 IRVINE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3031
Practice Address - Country:US
Practice Address - Phone:714-734-9363
Practice Address - Fax:714-734-9362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA000081223S0112X
CAG73560204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty