Provider Demographics
NPI:1154998821
Name:LEE, STEPHANIE J (DMD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:J
Last Name:LEE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 SPRUCE ST RM 204
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-2648
Mailing Address - Country:US
Mailing Address - Phone:415-221-1788
Mailing Address - Fax:
Practice Address - Street 1:500 SPRUCE ST RM 204
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-2648
Practice Address - Country:US
Practice Address - Phone:415-221-1788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1044651223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics