Healthcare Provider Details

I. General information

NPI: 1235051459
Provider Name (Legal Business Name): QUINCEY GRACE LEE RDH, BASDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SE 160TH AVE STE 121
VANCOUVER WA
98684-8910
US

IV. Provider business mailing address

700 SE 160TH AVE STE 121
VANCOUVER WA
98684-8910
US

V. Phone/Fax

Practice location:
  • Phone: 360-996-1078
  • Fax:
Mailing address:
  • Phone: 360-996-1078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number70142028
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: