Healthcare Provider Details

I. General information

NPI: 1376613414
Provider Name (Legal Business Name): CARYN H LEE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 02/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10238 E HAMPTON AVE #105
MESA AZ
85208
US

IV. Provider business mailing address

10238 E HAMPTON AVE #105
MESA AZ
85208
US

V. Phone/Fax

Practice location:
  • Phone: 480-986-2600
  • Fax: 480-986-4164
Mailing address:
  • Phone: 480-986-2600
  • Fax: 480-986-4164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number6627
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD6627
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: