Organization
LEE FAMILY DENTSTRY, LLC
Active
Other names
Fort O Smiles
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACOB LEE DDS (OWNER)
(706) 686-6011
Entity
Organization
Contact information
Practice address
138 BATTLEWOOD DR, FORT OGLETHORPE, GA 30742-4006
(706) 686-6011
(706) 820-6854
Mailing address
138 BATTLEWOOD DR, FORT OGLETHORPE, GA 30742-4006
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
DN011116
GA
1223G0001X
General Practice Dentistry
Primary
DN013134
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000583085C
—
GA
05
—
076800461B
—
GA
Enumeration date
04/30/2015
Last updated
04/30/2015
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