Healthcare Provider Details

I. General information

NPI: 1588619274
Provider Name (Legal Business Name): ROBERT ANDREW LEES II DDS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 W SOUTHERN AVENUE SUITE 102
MESA AZ
85202-4704
US

IV. Provider business mailing address

2220 W SOUTHERN AVENUE SUITE 102
MESA AZ
85202-4704
US

V. Phone/Fax

Practice location:
  • Phone: 480-834-7100
  • Fax: 480-833-3134
Mailing address:
  • Phone: 480-834-7100
  • Fax: 480-833-3134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number1714
License Number StateAZ

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: