Provider Demographics
NPI:1952538035
Name:LEE, JAE HOON (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAE
Middle Name:HOON
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 1:7474 SKILLMAN ST APT 309
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-8309
Mailing Address - Country:US
Mailing Address - Phone:504-339-1179
Mailing Address - Fax:
Practice Address - Street 1:6501 WINDCREST DR STE 100
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3087
Practice Address - Country:US
Practice Address - Phone:972-212-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX246361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice