Active NPI
Jaebum Lee, DDS, MSD, PHD
- Periodontics
- Coppell, TX
National Provider Identifier
1083921340
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 29604
- Practice address
- 897 N Macarthur Blvd Ste 100
Coppell, TX 75019-2706 - Phone
- (972) 315-2345
- NPI assigned
- Sep 8, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 29604 | TX | Primary |
Addresses
Primary practice location
897 N Macarthur Blvd Ste 100
Coppell, TX 75019-2706
Mailing address
897 N Macarthur Blvd Ste 100
Coppell, TX 75019-2706
Phone (972) 315-2345
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29604 | TX | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1283904000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1680134400000",
"number": "1083921340",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "897 N MACARTHUR BLVD STE 100",
"city": "COPPELL",
"state": "TX",
"postal_code": "750192706",
"telephone_number": "972-315-2345"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "897 N MACARTHUR BLVD STE 100",
"city": "COPPELL",
"state": "TX",
"postal_code": "750192706",
"telephone_number": "972-315-2345"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "JAEBUM",
"name_prefix": "Dr.",
"credential": "DDS, MSD, PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-09-08",
"last_updated": "2023-03-30",
"certification_date": "2021-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "TX",
"license": "29604",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coppell, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.