| Brandon W Lee Dds Pc | |
|
4444 W Northern Ave Suite A3 Glendale AZ 85301 | |
| (623) 842-1075 | |
| (623) 931-5881 |
| Full Name | Brandon W Lee Dds Pc |
|---|---|
| Speciality | Dentist |
| Location | 4444 W Northern Ave, Glendale, Arizona |
| Authorized Official Name and Position | Wonseok Lee (OWNER) |
| Authorized Official Contact | 6238421075 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Brandon W Lee Dds Pc 4444 W Northern Ave Suite A3 Glendale AZ 85301 Ph: (623) 842-1075 | Brandon W Lee Dds Pc 4444 W Northern Ave Suite A3 Glendale AZ 85301 Ph: (623) 842-1075 |
| NPI Number | 1124174602 |
|---|---|
| Provider Enumeration Date | 01/26/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124174602 | NPI | - | NPPES |
| 135229 | Other | AZ | AHCCCS |
| 533689 | Other | AETNA DENTAL INS | |
| 197338 | Other | UNITED CONCORDIA | |
| AZ0489860 | Other | AZ | BCBS DENTAL INS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 4338 (Arizona) | Primary |
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