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Organization

JIYOUNG E LEE DMD PC

Active
Other names
Gresham Pediatric Dentistry
Organization subpart
No

Provider details

NPI number
Authorized official
JIYOUNG LEE DMD (OWNER)
(503) 666-9436
Entity
Organization

Contact information

Practice address
831 NW COUNCIL DR STE 210, GRESHAM, OR 97030-3724
(503) 666-9436
Mailing address
831 NW COUNCIL DR, STE 210, GRESHAM, OR 97030-3721
(503) 761-2243
(503) 761-1540

Taxonomy

Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
D8776
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
028475
OR
Enumeration date
02/17/2012
Last updated
06/23/2020
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