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Organization
ETHAN C.A. LEE DENTAL INC.
Active
Organization
ETHAN C.A. LEE DENTAL INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ETHAN C.A. LEE DDS (DDS)
(626) 458-3410
Entity
Organization
Contact information
Practice address
314 W. VALLEY BLVD, SAN GABRIEL, CA 91776
(626) 458-3410
(626) 458-3411
Mailing address
314 W. VALLEY BLVD, SAN GABRIEL, CA 91776
(626) 458-3410
(626) 458-3411
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
48688
CA
1223G0001X
General Practice Dentistry
48595
CA
Other
Enumeration date
05/25/2018
Last updated
05/25/2018
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