Organization
LEE D JESS DDS LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LEE DALE JESS D.D.S. (OWNER, PRESIDENT)
(218) 326-3231
Entity
Organization
Contact information
Practice address
501 S POKEGAMA AVE, SUITE 101, GRAND RAPIDS, MN 55744-3838
(218) 326-3231
(218) 326-4619
Mailing address
501 S POKEGAMA AVE, SUITE 101, GRAND RAPIDS, MN 55744-3838
(218) 326-3231
(218) 326-4619
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7035
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
038015600
—
MN
Enumeration date
11/15/2006
Last updated
06/10/2008
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