Provider Demographics
NPI:1265519920
Name:LEE PAIR, REBECCA C (DDS)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:C
Last Name:LEE PAIR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:11200 CORBIN AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91326
Mailing Address - Country:US
Mailing Address - Phone:818-831-8252
Mailing Address - Fax:818-831-8255
Practice Address - Street 1:11200 CORBIN AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91326
Practice Address - Country:US
Practice Address - Phone:818-831-8252
Practice Address - Fax:818-831-8255
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46197122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist