Provider Demographics
NPI:1568664472
Name:LEE, JULIA (DDS)
Entity type:Individual
Prefix:DR
First Name:JULIA
Middle Name:
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:PO BOX 1676
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-6676
Mailing Address - Country:US
Mailing Address - Phone:925-915-0605
Mailing Address - Fax:925-930-8727
Practice Address - Street 1:1479 YGNACIO VALLEY RD
Practice Address - Street 2:SUITE 105
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2986
Practice Address - Country:US
Practice Address - Phone:925-682-8810
Practice Address - Fax:925-930-8727
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA446091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20-8900325OtherTAX IDENTIFICATION NUMBER