Individual
DR. EUN JIN LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S
Contact information
Practice address
3115 WILLIAMSON COUNTY PKWY, MARION, IL 62959-5235
(618) 969-8600
(618) 997-8978
Mailing address
109 CALIFORNIA ST, PO BOX 577, CARTERVILLE, IL 62918-1923
(618) 985-8221
(618) 985-4635
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019029033
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019029033
—
IL
Enumeration date
06/09/2012
Last updated
02/03/2015
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