Individual ProviderGajin LeeDentistDental ProvidersPractice Address461 Western Blvd Ste 104, Jacksonville, NC 28546-7637(910) 346-2202(551) 404-8394PECOS EnrollmentBased on the most recent information from CMS, provider Gajin Lee does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 9 days ago.Profile DetailsProvider ID1689377483Provider TypeIndividualFull NameLee, GajinGenderFemaleSole ProprietorNoEnumeration Date3/22/2023Last Updated7/12/2025Contact InformationPractice LocationPractice Address461 Western Blvd Ste 104, Jacksonville, NC 28546-7637Phone(910) 346-2202FaxUnlisted FaxMailing LocationMailing Address5079 Western Blvd Apt 3f, Jacksonville, NC 28546-7187Phone(551) 404-8394FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode1223G0001XPrimaryDescriptionDentistDental ProvidersLicense14331North Carolina