Provider Demographics
NPI:1063545564
Name:LEE, DORA (DDS)
Entity type:Individual
Prefix:DR
First Name:DORA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4608 KATELLA AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2685
Mailing Address - Country:US
Mailing Address - Phone:562-596-8668
Mailing Address - Fax:562-596-4646
Practice Address - Street 1:4608 KATELLA AVE STE 101
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2685
Practice Address - Country:US
Practice Address - Phone:562-596-8668
Practice Address - Fax:562-596-4646
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA473851223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry