Provider Demographics
NPI:1649500166
Name:DAVID BO LEE, DDS, INC.
Entity type:Organization
Organization Name:DAVID BO LEE, DDS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BO
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-525-1130
Mailing Address - Street 1:942 W ORANGETHORPE AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-2827
Mailing Address - Country:US
Mailing Address - Phone:714-525-1130
Mailing Address - Fax:714-525-1415
Practice Address - Street 1:942 W ORANGETHORPE AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-2827
Practice Address - Country:US
Practice Address - Phone:714-525-1130
Practice Address - Fax:714-525-1415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB46196-01OtherDELTA DENTAL HEALTHY FAMILY
CAG93421-01OtherMEDI-CAL PROVIDER #