Provider Demographics
NPI:1730474511
Name:LEE, GLORIA (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:
Last Name:LEE
Suffix:
Gender:
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2323 S 109TH ST STE 275
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-1912
Mailing Address - Country:US
Mailing Address - Phone:414-269-8108
Mailing Address - Fax:414-269-8109
Practice Address - Street 1:2323 S 109TH ST STE 275
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-1912
Practice Address - Country:US
Practice Address - Phone:414-269-8108
Practice Address - Fax:414-269-8109
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2025-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1002413-151223G0001X, 1223X0400X, 1223G0001X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice