Individual
GRACE H LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
61 W 144TH ST, RIVERDALE, IL 60827-2850
(708) 849-8627
Mailing address
1515 S PRAIRIE AVE UNIT 506, CHICAGO, IL 60605-3020
(773) 332-0131
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
IL
Other
Enumeration date
08/07/2007
Last updated
08/07/2007
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