Provider Demographics
NPI:1528443751
Name:LEE, JAMES (BDS HONS)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:BDS HONS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 WASHINGTON AVE SE
Mailing Address - Street 2:APARTMENT 619A
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-2996
Mailing Address - Country:US
Mailing Address - Phone:612-814-2704
Mailing Address - Fax:
Practice Address - Street 1:6545 FRANCE AVE S STE 680
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2127
Practice Address - Country:US
Practice Address - Phone:952-922-5326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-29
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR6351223P0700X
MNS1561223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics