MEDICARE: DR. ELAINE CHRISTINA 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	1223G0001X	General Practice Dentistry	105110	CA

General Provider Information

NPI Number	:	1811585565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELAINE CHRISTINA LEE DDS

Provider Business Mailing Address
First Line	:	5137 FAWN HOLLOW WAY
Second Line	:
City	:	ANTELOPE
State	:	CA
Zip	:	95843-4643
Country	:	US
Telephone Number	:	916-273-0887
Fax Number	:

Provider Business Practice Location Address
First Line	:	6024 SAN JUAN AVE STE C
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95610-5643
Country	:	US
Telephone Number	:	916-728-2888
Fax Number	:

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

Provider Enumeration Date	:	01/07/2021
Last Update Date	:	01/07/2021

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