| 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 | 122300000X Dentist |
| Additional Taxonomies | 122300000X Dentist (Licence: CA DDS14162) |
| Enumeration Date | 2017-04-27 |
| Last Update Date | 2021-05-17 |