Provider Demographics
NPI:1528137429
Name:LEE, FREDERICK Y (DDS)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:Y
Last Name:LEE
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 1:810 AVENIDA PICO,
Mailing Address - Street 2:SUITE W
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-5624
Mailing Address - Country:US
Mailing Address - Phone:949-369-7200
Mailing Address - Fax:949-369-7700
Practice Address - Street 1:810 AVENIDA PICO
Practice Address - Street 2:SUITE W
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-5624
Practice Address - Country:US
Practice Address - Phone:949-369-7200
Practice Address - Fax:949-369-7700
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA217251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice