Active NPI
Daniel Lee, DDS
- General Practice Dentistry
- Rohnert Park, CA
National Provider Identifier
1205310182
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 102944
- Practice address
- 5900 State Farm Dr FL 2
Rohnert Park, CA 94928-2149 - Phone
- (707) 559-7500
- NPI assigned
- Sep 18, 2018
- Last updated
- Apr 30, 2021
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 34601 | TX | |
| General Practice Dentistry | 1223G0001X | 102944 | CA | Primary |
Addresses
Primary practice location
5900 State Farm Dr FL 2
Rohnert Park, CA 94928-2149
Mailing address
43913 S Moray St
Fremont, CA 94539-5942
Phone (510) 579-3772
Other practice location 1
6808 Harrisburg Blvd
Houston, TX 77011-4626
Phone (713) 928-6600
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34601 | TX | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Petaluma Health Center, Inc. | Current | Accepting new patients | |
| Houston DDS, PC | General Practice | Past | Accepting new patients |
| Houston Dentistry PC | General Practice | Past | Accepting new patients |
Locations
5900 State Farm Dr
Fl 2
Rohnert Park, CA 94928
Phone (707) 559-7600
Interoperability endpoints
- dlee585076@direct.ochin.org
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Rohnert Park Health Center Pharmacy
- Community/Retail Pharmacy
- Rohnert Park, CA
- NPI 1205629722
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1537228800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1619740800000",
"number": "1205310182",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "43913 S MORAY ST",
"city": "FREMONT",
"state": "CA",
"postal_code": "945395942",
"telephone_number": "510-579-3772"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5900 STATE FARM DR FL 2",
"city": "ROHNERT PARK",
"state": "CA",
"postal_code": "949282149",
"telephone_number": "707-559-7500"
}
],
"practiceLocations": [
{
"address_1": "6808 Harrisburg Blvd",
"address_purpose": "LOCATION",
"city": "Houston",
"state": "TX",
"postal_code": "770114626",
"country_code": "US",
"telephone_number": "713-928-6600",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LEE",
"first_name": "DANIEL",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-09-18",
"last_updated": "2021-04-30",
"certification_date": "2021-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "34601",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "102944",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Rohnert Park, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.