Provider Demographics
NPI:1386397065
Name:IGNATIUS K. LEE DDS PA
Entity type:Organization
Organization Name:IGNATIUS K. LEE DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IGNATIUS
Authorized Official - Middle Name:K
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-736-1080
Mailing Address - Street 1:14400 W BURNSVILLE PKWY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55306-4983
Mailing Address - Country:US
Mailing Address - Phone:952-736-1080
Mailing Address - Fax:952-736-1091
Practice Address - Street 1:14400 W BURNSVILLE PKWY
Practice Address - Street 2:SUITE 2
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55306-4983
Practice Address - Country:US
Practice Address - Phone:952-736-1080
Practice Address - Fax:952-736-1091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental