Provider Demographics
NPI:1366052789
Name:LEE, JOSHUA (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1954 TYLER TRCE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-2931
Mailing Address - Country:US
Mailing Address - Phone:770-841-7247
Mailing Address - Fax:
Practice Address - Street 1:160 MOVIE ROW
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6532
Practice Address - Country:US
Practice Address - Phone:615-930-9606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-01
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN112811223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty