Healthcare Provider Details

I. General information

NPI: 1932645827
Provider Name (Legal Business Name): TIFFANY KAFEI LEE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2017
Last Update Date: 11/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 E CENTENNIAL PKWY STE 110
NORTH LAS VEGAS NV
89081-5605
US

IV. Provider business mailing address

2345 E CENTENNIAL PKWY STE 110
NORTH LAS VEGAS NV
89081-5605
US

V. Phone/Fax

Practice location:
  • Phone: 702-991-0404
  • Fax: 702-991-0404
Mailing address:
  • Phone: 702-991-0404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number63003
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberS5-46C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: