Provider Demographics
NPI:1699978965
Name:LEE, LAWRENCE C (DDS)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:C
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:LAWRENCE
Other - Middle Name:C
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:777 SOUTHLAND DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-1539
Mailing Address - Country:US
Mailing Address - Phone:510-782-1875
Mailing Address - Fax:510-786-2945
Practice Address - Street 1:777 SOUTHLAND DR
Practice Address - Street 2:SUITE 200
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-1539
Practice Address - Country:US
Practice Address - Phone:510-782-1875
Practice Address - Fax:510-786-2945
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0202211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice