Provider Demographics
NPI:1528673415
Name:STEPHEN M. LEE, DDS
Entity type:Organization
Organization Name:STEPHEN M. LEE, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:MING
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-272-0967
Mailing Address - Street 1:345 9TH ST STE 304
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-6523
Mailing Address - Country:US
Mailing Address - Phone:510-272-0967
Mailing Address - Fax:510-272-0969
Practice Address - Street 1:345 9TH ST STE 304
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-6523
Practice Address - Country:US
Practice Address - Phone:510-272-0967
Practice Address - Fax:510-272-0969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-09
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental