| S Lee Dental Corporation | |
|
23571 Lake Dr Crestline CA 92325-9432 | |
| (909) 338-1782 | |
| Not Available |
| Full Name | S Lee Dental Corporation |
|---|---|
| Speciality | Dentist |
| Location | 23571 Lake Dr, Crestline, California |
| Authorized Official Name and Position | Sean Lee (OWNER) |
| Authorized Official Contact | 9098247000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| S Lee Dental Corporation 23571 Lake Dr Crestline CA 92325-9432 Ph: (909) 338-1782 | S Lee Dental Corporation 23571 Lake Dr Crestline CA 92325-9432 Ph: (909) 338-1782 |
| NPI Number | 1801553540 |
|---|---|
| Provider Enumeration Date | 11/17/2021 |
| Last Update Date | 11/17/2021 |
| Medicare PECOS PAC ID | 6800287806 |
|---|---|
| Medicare Enrollment ID | O20211230001383 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801553540 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
| Provider Name | Sean Lee |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1497912281 PECOS PAC ID: 9436441078 Enrollment ID: I20191009002798 |
S Lee Dental Corporation Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 23571 Lake Dr, Crestline, CA 92325 Phone: 909-338-1782 |