Healthcare Provider Details

I. General information

NPI: 1053097055
Provider Name (Legal Business Name): ASHLEY LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2023
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 EXECUTIVE PKWY STE 350
EUGENE OR
97401-7110
US

IV. Provider business mailing address

3590 GOODPASTURE LOOP APT 101
EUGENE OR
97401-1625
US

V. Phone/Fax

Practice location:
  • Phone: 541-485-0175
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberD11671
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: