Provider Demographics
NPI:1982093316
Name:JOSEPH LEE DENTAL
Entity type:Organization
Organization Name:JOSEPH LEE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-381-1364
Mailing Address - Street 1:9491 FOOTHILL BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3570
Mailing Address - Country:US
Mailing Address - Phone:909-962-7722
Mailing Address - Fax:909-962-7723
Practice Address - Street 1:9491 FOOTHILL BLVD STE E
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3570
Practice Address - Country:US
Practice Address - Phone:909-962-7722
Practice Address - Fax:909-962-7723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA527481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty