Provider Demographics
NPI:1063521185
Name:LEE, CHRISTINE S (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:S
Last Name:LEE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5250 GRAND AVE
Mailing Address - Street 2:#7
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-1877
Mailing Address - Country:US
Mailing Address - Phone:847-662-7755
Mailing Address - Fax:847-662-7723
Practice Address - Street 1:5250 GRAND AVE
Practice Address - Street 2:#7
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-1877
Practice Address - Country:US
Practice Address - Phone:847-662-7755
Practice Address - Fax:847-662-7723
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry