| Simon Lee Dental | |
|
15130 Lakeshore Dr Clearlake CA 95422 | |
| (707) 994-6000 | |
| (707) 994-7589 |
| Full Name | Simon Lee Dental |
|---|---|
| Speciality | Dentist |
| Location | 15130 Lakeshore Dr, Clearlake, California |
| Authorized Official Name and Position | Simon Hyun Lee (OWNER) |
| Authorized Official Contact | 7079946000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Simon Lee Dental 15130 Lakeshore Dr Clearlake CA 95422 Ph: (707) 994-6000 | Simon Lee Dental 15130 Lakeshore Dr Clearlake CA 95422 Ph: (707) 994-6000 |
| NPI Number | 1295845717 |
|---|---|
| Provider Enumeration Date | 08/30/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295845717 | NPI | - | NPPES |
| G9342001 | Other | CA | MEDICAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 37978 (California) | Primary |
Lakeshore Dental Practice Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 15322 Lakeshore Drive, Suite 104, Clearlake, CA 95422 Phone: 707-994-6050 Fax: 707-994-8049 |