| Ethan C.a. Lee Dental Inc. | |
|
314 W. Valley Blvd San Gabriel CA 91776 | |
| (626) 458-3410 | |
| (626) 458-3411 |
| Full Name | Ethan C.a. Lee Dental Inc. |
|---|---|
| Speciality | Dentist |
| Location | 314 W. Valley Blvd, San Gabriel, California |
| Authorized Official Name and Position | Ethan C.a. Lee (DDS) |
| Authorized Official Contact | 6264583410 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ethan C.a. Lee Dental Inc. 314 W. Valley Blvd San Gabriel CA 91776 Ph: (626) 458-3410 | Ethan C.a. Lee Dental Inc. 314 W. Valley Blvd San Gabriel CA 91776 Ph: (626) 458-3410 |
| NPI Number | 1477044345 |
|---|---|
| Provider Enumeration Date | 05/25/2018 |
| Last Update Date | 05/25/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477044345 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 48688 (California) | Primary |
| 1223G0001X | Dentist - General Practice | 48595 (California) | Secondary |
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