Provider Demographics
NPI:1699882407
Name:LEE W. PLUNKETT, D.M.D., P.C.
Entity type:Organization
Organization Name:LEE W. PLUNKETT, D.M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:W
Authorized Official - Last Name:PLUNKETT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-452-0222
Mailing Address - Street 1:4675 N SHALLOWFORD RD
Mailing Address - Street 2:SUITE 118
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6309
Mailing Address - Country:US
Mailing Address - Phone:770-452-0222
Mailing Address - Fax:770-451-2005
Practice Address - Street 1:4675 N SHALLOWFORD RD
Practice Address - Street 2:SUITE 118
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-6309
Practice Address - Country:US
Practice Address - Phone:770-452-0222
Practice Address - Fax:770-451-2005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0084451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty