Provider Demographics
NPI:1932549607
Name:LEE, JOHN JAEWOO (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JAEWOO
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 1:8333 BRAESMAIN DR
Mailing Address - Street 2:APT #1402
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-2940
Mailing Address - Country:US
Mailing Address - Phone:972-786-6920
Mailing Address - Fax:
Practice Address - Street 1:7599 GARTH RD STE 800
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-7720
Practice Address - Country:US
Practice Address - Phone:972-786-6920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29168122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist