Active NPI
Brandon W Lee DDS PC
- Dentist
- Glendale, AZ
National Provider Identifier
1124174602
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 4338
- Legal business name
- BRANDON W LEE DDS PC
- Practice address
- 4444 W Northern Ave
Suite A3
Glendale, AZ 85301 - Phone
- (623) 842-1075
- Fax
- (623) 931-5881
- NPI assigned
- Jan 26, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Wonseok Lee, DDS
- Title
- Owner
- Phone
- (623) 842-1075
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 4338 | AZ | Primary |
Addresses
Primary practice location
4444 W Northern Ave
Suite A3
Glendale, AZ 85301
Mailing address
4444 W Northern Ave
Suite A3
Glendale, AZ 85301
Phone (623) 842-1075
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 135229 | Other | AZ | AHCCCS |
| 533689 | Other | AETNA DENTAL INS | |
| 197338 | Other | UNITED CONCORDIA | |
| AZ0489860 | Other | AZ | BCBS DENTAL INS |
National Provider Directory
National Provider DirectoryLocations
4444 W Northern Ave
Ste A3
Glendale, AZ 85301
Phone (623) 842-1075
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Dentist
- Glendale, AZ
- NPI 1841323672
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169769600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1124174602",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4444 W NORTHERN AVE",
"address_2": "SUITE A3",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "85301",
"telephone_number": "623-842-1075",
"fax_number": "623-931-5881"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4444 W NORTHERN AVE",
"address_2": "SUITE A3",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "85301",
"telephone_number": "623-842-1075",
"fax_number": "623-931-5881"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BRANDON W LEE DDS PC",
"organizational_subpart": "NO",
"enumeration_date": "2007-01-26",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "LEE",
"authorized_official_first_name": "WONSEOK",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "623-842-1075",
"authorized_official_credential": "DDS"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist",
"state": "AZ",
"license": "4338",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AHCCCS",
"identifier": "135229",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA DENTAL INS",
"identifier": "533689",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "197338",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS DENTAL INS",
"identifier": "AZ0489860",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Glendale, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.