Provider Demographics
NPI:1528352861
Name:LEE, ANNA EUN (DDS)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:EUN
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 1:102 BARDWELL DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-3912
Mailing Address - Country:US
Mailing Address - Phone:469-855-2283
Mailing Address - Fax:
Practice Address - Street 1:5057 KELLER SPRINGS RD
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-6231
Practice Address - Country:US
Practice Address - Phone:214-522-2008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-03
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26530122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist