Healthcare Provider Details

I. General information

NPI: 1518056886
Provider Name (Legal Business Name): ADAM NELSON LEE B.S., D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 S 500 W
PAYSON UT
84651-3203
US

IV. Provider business mailing address

712 E 320 S
SALEM UT
84653-8533
US

V. Phone/Fax

Practice location:
  • Phone: 801-465-1118
  • Fax: 801-465-4567
Mailing address:
  • Phone: 801-423-0908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number5662742-9921
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier5662742-9921
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerPROFFESSIONAL LICENCE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: