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Organization

BRANDON W LEE DDS PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
WONSEOK LEE DDS (OWNER)
(623) 842-1075
Entity
Organization

Contact information

Practice address
4444 W NORTHERN AVE, SUITE A3, GLENDALE, AZ 85301
(623) 842-1075
(623) 931-5881
Mailing address
4444 W NORTHERN AVE, SUITE A3, GLENDALE, AZ 85301
(623) 842-1075
(623) 931-5881

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4338
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
135229
AHCCCS
AZ
01
197338
UNITED CONCORDIA
01
533689
AETNA DENTAL INS
01
AZ0489860
BCBS DENTAL INS
AZ
Enumeration date
01/26/2007
Last updated
08/22/2020
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