Healthcare Provider Details

I. General information

NPI: 1902834302
Provider Name (Legal Business Name): DANIEL HARVEY LEE DDS, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 11/02/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4132 S RAINBOW BLVD STE 286
LAS VEGAS NV
89103-3106
US

IV. Provider business mailing address

4132 S RAINBOW BLVD STE 286
LAS VEGAS NV
89103-3106
US

V. Phone/Fax

Practice location:
  • Phone: 949-283-2763
  • Fax:
Mailing address:
  • Phone: 949-283-2763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number56861
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: