Provider Demographics
NPI:1104248566
Name:JOSEPH W. LEE, A PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:JOSEPH W. LEE, A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:WEITAI
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-869-8500
Mailing Address - Street 1:888 BREA CANYON RD
Mailing Address - Street 2:STE 210
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91789
Mailing Address - Country:US
Mailing Address - Phone:909-869-8500
Mailing Address - Fax:909-869-8505
Practice Address - Street 1:888 BREA CANYON RD
Practice Address - Street 2:STE 210
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91789
Practice Address - Country:US
Practice Address - Phone:909-869-8500
Practice Address - Fax:909-869-8505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-20
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60609122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty