Provider Demographics
NPI:1316977911
Name:LEE, JANICE (DDS)
Entity type:Individual
Prefix:
First Name:JANICE
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 1:92-605 MAKAKILO DR
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-1288
Mailing Address - Country:US
Mailing Address - Phone:808-672-0397
Mailing Address - Fax:
Practice Address - Street 1:92-605 MAKAKILO DRIVE
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-1288
Practice Address - Country:US
Practice Address - Phone:808-672-0397
Practice Address - Fax:808-672-5730
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI21211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice