| Organization Name: | LEE DENTURE CLINIC, LLC |
| NPI Number: | 1710313051 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | HEACHAN LEE (DENTURIST) |
| Mailing Address: | 4055 Sw 185th Ave Suite 220 Aloha |
| State: | OR US |
| Postal Code: | 97006 |
| Phone Number: | 5037464770 |
| Fax Number: | 5037464915 |
| NPI Enumeration Date: | 09/18/2013 |
| NPI Last Update Date: | 09/18/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 122400000X |
| License Number: | DT-DO-10126667 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Denturist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |