Provider Demographics
NPI:1033284849
Name:LEE, PRISCILLA GINGER (DDS)
Entity type:Individual
Prefix:DR
First Name:PRISCILLA
Middle Name:GINGER
Last Name:LEE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 E. IMPERIAL HIGHWAY
Mailing Address - Street 2:SUITE E-11
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-5617
Mailing Address - Country:US
Mailing Address - Phone:714-990-9210
Mailing Address - Fax:714-990-5051
Practice Address - Street 1:1033 E IMPERIAL HWY
Practice Address - Street 2:SUITE E-11
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-5606
Practice Address - Country:US
Practice Address - Phone:714-990-9210
Practice Address - Fax:714-990-5051
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA299481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice