Provider Demographics
NPI:1528112265
Name:DAVID D. LEE DDS.PROFESSIONAL DENTAL CORP.
Entity type:Organization
Organization Name:DAVID D. LEE DDS.PROFESSIONAL DENTAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:D
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:530-241-1129
Mailing Address - Street 1:2138 COURT ST STE A
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2545
Mailing Address - Country:US
Mailing Address - Phone:530-241-1129
Mailing Address - Fax:530-241-1188
Practice Address - Street 1:2138 COURT ST. STE A
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1912
Practice Address - Country:US
Practice Address - Phone:530-241-1129
Practice Address - Fax:530-241-1188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA363891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty