| NPI | 1083149942 |
|---|---|
| Former Legal Business Name | A DENTAL PRACTICE OF GANNON LEE |
| Entity Type | Organization |
| Authorized Contact | GANNON KA LEE Owner 949-448-7667 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2017-04-27 |
| Last Update Date | 2025-07-21 |