Healthcare Provider Details

I. General information

NPI: 1679361273
Provider Name (Legal Business Name): AMBER LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2025
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 SE 117TH AVE STE 230
VANCOUVER WA
98683-5297
US

IV. Provider business mailing address

8430 NE 50TH CT
VANCOUVER WA
98665-2031
US

V. Phone/Fax

Practice location:
  • Phone: 360-892-1170
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDENT.DE.70161515
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: