Provider Demographics
NPI:1285706226
Name:JESS, LEE DALE (DDS)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:DALE
Last Name:JESS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S POKEGAMA AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-3838
Mailing Address - Country:US
Mailing Address - Phone:218-326-3231
Mailing Address - Fax:218-326-4619
Practice Address - Street 1:501 S POKEGAMA AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-3838
Practice Address - Country:US
Practice Address - Phone:218-326-3231
Practice Address - Fax:218-326-4619
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN70351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice