Healthcare Provider Details

I. General information

NPI: 1730028812
Provider Name (Legal Business Name): SHANDRA LEE DMD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 S 15TH ST STE 101
MOUNT VERNON WA
98274-4569
US

IV. Provider business mailing address

130 S 15TH ST STE 101
MOUNT VERNON WA
98274-4569
US

V. Phone/Fax

Practice location:
  • Phone: 360-428-4393
  • Fax:
Mailing address:
  • Phone: 360-428-4393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. SHANDRA LEE
Title or Position: OWNER
Credential: DMD
Phone: 360-428-4393