Provider Demographics
NPI:1952960569
Name:LEE, LIAM
Entity Type:Individual
Prefix:
First Name:LIAM
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40680 CALIFORNIA OAKS RD STE 2C
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-5755
Mailing Address - Country:US
Mailing Address - Phone:951-894-6440
Mailing Address - Fax:
Practice Address - Street 1:40680 CALIFORNIA OAKS RD STE 2C
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5755
Practice Address - Country:US
Practice Address - Phone:951-894-6440
Practice Address - Fax:951-894-5570
Is Sole Proprietor?:No
Enumeration Date:2019-06-07
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019032378122300000X
AZ10868122300000X
CA106323122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist