MEDICARE: MRS. JUDY A LEES R.D.H.A.P.

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	124Q00000X	Dental Hygienist	RDHAP 159	CA

General Provider Information

NPI Number	:	1285799742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JUDY A LEES R.D.H.A.P.

Provider Business Mailing Address
First Line	:	5753 HWY 85 NORTH
Second Line	:	#2713
City	:	CRESTVIEW
State	:	FL
Zip	:	32536-8823
Country	:	US
Telephone Number	:	909-744-2752
Fax Number	:

Provider Business Practice Location Address
First Line	:	2675 VIKING LANE
Second Line	:
City	:	RUNNING SPRINGS
State	:	CA
Zip	:	92382-1535
Country	:	US
Telephone Number	:	909-744-2752
Fax Number	:

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

Provider Enumeration Date	:	12/26/2006
Last Update Date	:	05/31/2016

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