Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days.
Organization
PEDIATRIC DENTISTRY OF SAN CLEMENTE
Active
Organization
PEDIATRIC DENTISTRY OF SAN CLEMENTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB K LEE DDS (CEO)
(949) 361-2838
Entity
Organization
Contact information
Practice address
903 CALLE AMANECER STE 110, SAN CLEMENTE, CA 92673-6253
(949) 361-2838
Mailing address
903 CALLE AMANECER STE 110, SAN CLEMENTE, CA 92673-6253
(949) 361-2838
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1083768725
NPPES
CA
01
—
1437689395
NPPES
CA
01
—
1790281202
NPPES
CA
Enumeration date
10/11/2023
Last updated
10/11/2023
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up