Lee Family Dentstry, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN013134 Issued in GA

Legal business name

LEE FAMILY DENTSTRY, LLC

Doing business as

Fort O Smiles

Practice address

138 Battlewood Dr
Fort Oglethorpe, GA 30742-4006

Phone

(706) 686-6011

Fax

(706) 820-6854

NPI assigned

Apr 30, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Jacob Lee, DDS

Title

Owner

Phone

(706) 686-6011

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Fort O Smiles Doing business as

Locations

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

{
    "created_epoch": "1430352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430352000000",
    "number": "1720465602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "138 BATTLEWOOD DR",
            "city": "FORT OGLETHORPE",
            "state": "GA",
            "postal_code": "307424006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "138 BATTLEWOOD DR",
            "city": "FORT OGLETHORPE",
            "state": "GA",
            "postal_code": "307424006",
            "telephone_number": "706-686-6011",
            "fax_number": "706-820-6854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEE FAMILY DENTSTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-30",
        "last_updated": "2015-04-30",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "JACOB",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "706-686-6011",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN013134",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN011116",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000583085C",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "076800461B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fort O Smiles",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Taylor Kinnison, PT, DPT
• Terry Knighton, CAC
• Ira H Kraus, DPM
• Ken K Kwok, M.D.
• Trisha Lawson
• Nicole Everett Lee, OTR/L
• Sungchan Lee
• Tanner Mitchell Lee
• Graceline Levan, OTD, OTR/L
• Emily Lewis, MS CCC-SLP

• General Practice Dentistry in Fort Oglethorpe, GA
• Providers in Fort Oglethorpe, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2015; 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.