Healthcare Provider Details

I. General information

NPI: 1932166139
Provider Name (Legal Business Name): JAMES LAWRENCE LEE JR. D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 S WALDRON RD
FORT SMITH AR
72903-2574
US

IV. Provider business mailing address

1501 S WALDRON RD
FORT SMITH AR
72903-2574
US

V. Phone/Fax

Practice location:
  • Phone: 479-452-8650
  • Fax:
Mailing address:
  • Phone: 479-452-8650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number1957
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: