1497010284 NPI number — DUNES DENTAL SERVICES INC

Table of content: DR. JONATHAN YOUNG LEE M.D. (NPI 1578591517)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497010284 NPI number — DUNES DENTAL SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DUNES DENTAL SERVICES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497010284
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 SUTTER DR
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
SURFSIDE BEACH
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29575-8665
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-215-2140
Provider Business Mailing Address Fax Number:
843-215-2141

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 SUTTER DR
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
SURFSIDE BEACH
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29575-8665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-215-2140
Provider Business Practice Location Address Fax Number:
843-215-2141
Provider Enumeration Date:
07/09/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MUNTEAN
Authorized Official First Name:
ALINA
Authorized Official Middle Name:
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
843-215-2140

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  4326 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)