NPIMap

Organization Active NPI

S Lee Dental Corporation

  • Dentist
  • Crestline, CA
National Provider Identifier
1376793133
Registry record updated Oct 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
36259 Issued in CA
Legal business name
S LEE DENTAL CORPORATION
Practice address
23571 Lake Dr
Crestline, CA 92325-9432
Phone
(909) 338-1782
NPI assigned
Sep 29, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sean S Lee, DDS
Title
Employer
Phone
(909) 338-1782

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 36259 CA Primary

Addresses

Primary practice location

23571 Lake Dr
Crestline, CA 92325-9432

Mailing address

PO Box 3009
Crestline, CA 92325-3009
Phone (909) 883-1782

National Provider Directory

National Provider Directory

Locations

4016 University Pkwy
San Bernardino, CA 92407
Phone (909) 880-1600

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1222646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696550400000",
    "number": "1376793133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3009",
            "city": "CRESTLINE",
            "state": "CA",
            "postal_code": "923253009",
            "telephone_number": "909-883-1782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23571 LAKE DR",
            "city": "CRESTLINE",
            "state": "CA",
            "postal_code": "923259432",
            "telephone_number": "909-338-1782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "S LEE DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-29",
        "last_updated": "2023-10-06",
        "certification_date": "2023-10-06",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "SEAN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "EMPLOYER",
        "authorized_official_telephone_number": "909-338-1782",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "36259",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crestline, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 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.

Verify at the official NPI Registry.