Healthcare Provider Details

I. General information

NPI: 1669014502
Provider Name (Legal Business Name): LEE DENTAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2019
Last Update Date: 10/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3706 N ROOSEVELT BLVD STE A
KEY WEST FL
33040-4566
US

IV. Provider business mailing address

3706 N ROOSEVELT BLVD STE A
KEY WEST FL
33040-4566
US

V. Phone/Fax

Practice location:
  • Phone: 305-332-4168
  • Fax: 305-735-4041
Mailing address:
  • Phone: 305-332-4168
  • Fax: 305-735-4041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WINNIE SITA LEE
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 305-332-4168