Provider Demographics
NPI:1902238728
Name:JAE S LEE, DDS, PA
Entity type:Organization
Organization Name:JAE S LEE, DDS, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:MEE
Authorized Official - Middle Name:K
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-388-7777
Mailing Address - Street 1:1500 PINEY PLAINS RD STE 101
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-6898
Mailing Address - Country:US
Mailing Address - Phone:919-388-7777
Mailing Address - Fax:919-388-7778
Practice Address - Street 1:1500 PINEY PLAINS RD STE 101
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-6898
Practice Address - Country:US
Practice Address - Phone:919-388-7777
Practice Address - Fax:919-388-7778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC80021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty