Provider Demographics
NPI:1174946206
Name:CHRISTINE N LEE DMD A PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:CHRISTINE N LEE DMD A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:NAM
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:916-686-4212
Mailing Address - Street 1:9381 E STOCKTON BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-5068
Mailing Address - Country:US
Mailing Address - Phone:916-686-4212
Mailing Address - Fax:916-686-4217
Practice Address - Street 1:9381 E STOCKTON BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-5068
Practice Address - Country:US
Practice Address - Phone:916-686-4212
Practice Address - Fax:916-686-4217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-24
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA619521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty