Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 56271 | CA |
NPI | 1073743944 |
---|---|
Provider Name | Dr. Teresa J. Lee |
First Address | Merced, CA 95348-2732 |
Second Address | Merced, CA 95348-2732 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2009 |
Last Update Date | 25/05/2011 |