MEDICARE: LILLA LEE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	12335390-9921	UT

General Provider Information

NPI Number	:	1174193122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILLA LEE DDS

Provider Business Mailing Address
First Line	:	618 DENTAL CO/US ARMY DENTAC-KOREA
Second Line	:	UNIT 15652
City	:	APO
State	:	AP
Zip	:	96271
Country	:	US
Telephone Number	:	253-968-4029
Fax Number	:

Provider Business Practice Location Address
First Line	:	CARL R. DARNALL ARMY MEDICAL CENTER
Second Line	:	590 MEDICAL CENTER RD
City	:	FORT HOOD
State	:	TX
Zip	:	76544-5060
Country	:	US
Telephone Number	:	989-482-4429
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2021
Last Update Date	:	05/29/2026

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