Healthcare Provider Details

I. General information

NPI: 1841170438
Provider Name (Legal Business Name): NATHAN H LEE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2025
Last Update Date: 09/04/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BUILDING S-180 USADC CARROLL #15748
APO AP
96260
US

IV. Provider business mailing address

PSC 313 BOX 2569
APO AP
96260-0026
US

V. Phone/Fax

Practice location:
  • Phone: 315-737-9479
  • Fax:
Mailing address:
  • Phone: 10-445-9376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14226302-9926
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14226302-9926
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: