Provider Demographics
NPI:1285120543
Name:LEE, DARIA HYERI (DDS)
Entity type:Individual
Prefix:DR
First Name:DARIA
Middle Name:HYERI
Last Name:LEE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:DARIA
Other - Middle Name:HYERI
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3440 OHIO ST
Mailing Address - Street 2:
Mailing Address - City:GREAT LAKES
Mailing Address - State:IL
Mailing Address - Zip Code:60088-3155
Mailing Address - Country:US
Mailing Address - Phone:734-417-7302
Mailing Address - Fax:
Practice Address - Street 1:3440 OHIO ST
Practice Address - Street 2:
Practice Address - City:GREAT LAKES
Practice Address - State:IL
Practice Address - Zip Code:60088-3155
Practice Address - Country:US
Practice Address - Phone:734-417-7302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901022715122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist