Provider Demographics
NPI:1730400797
Name:LEE, DAVID SUNGKU (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SUNGKU
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 TIFFANY DR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-9306
Mailing Address - Country:US
Mailing Address - Phone:919-774-6311
Mailing Address - Fax:919-775-4115
Practice Address - Street 1:407 TIFFANY DR
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-9306
Practice Address - Country:US
Practice Address - Phone:919-774-6311
Practice Address - Fax:919-775-4115
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC89651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice