Individual
JERRY LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
683 BIELENBERG DR STE 205, WOODBURY, MN 55125-1715
(651) 200-4747
Mailing address
683 BIELENBERG DR STE 205, WOODBURY, MN 55125-1715
(651) 200-4747
(651) 998-1009
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6972
OK
Other
Enumeration date
07/12/2017
Last updated
02/05/2021
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