Provider Demographics
NPI:1174731624
Name:LEE, VIRGINIA NGO (DMD)
Entity type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:NGO
Last Name:LEE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 MISSION CIRCLE
Mailing Address - Street 2:SUITE # 103
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409
Mailing Address - Country:US
Mailing Address - Phone:707-539-3503
Mailing Address - Fax:707-537-2012
Practice Address - Street 1:55 MISSION CIRCLE
Practice Address - Street 2:SUITE # 103
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409
Practice Address - Country:US
Practice Address - Phone:707-539-3503
Practice Address - Fax:707-537-2012
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA432871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice