Provider Demographics
NPI:1366713026
Name:LEE, SANGHUN SEAN (DMD)
Entity type:Individual
Prefix:
First Name:SANGHUN
Middle Name:SEAN
Last Name:LEE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 OSPREY CT
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-5851
Mailing Address - Country:US
Mailing Address - Phone:817-251-0534
Mailing Address - Fax:
Practice Address - Street 1:800 S CENTER ST
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-1815
Practice Address - Country:US
Practice Address - Phone:972-264-1662
Practice Address - Fax:972-264-6877
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-25
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27287122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist