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General NPI Number Information
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NPI Number | 1043611809
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Entity Type | Organization
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Legal Business Name | LEE DENTAL
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Dates
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Enumeration Date | 09/11/2014
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Last Update Date | 09/11/2014
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Provider Practice Location Address
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Address Line | 6351 PRESTON RD #300
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City | FRISCO
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State | TX
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Zip | 75034-6320
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Country | US
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Telephone | 972-712-9000
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Fax | 972-712-1941
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Provider Business Mailing Address
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Address Line | 6351 PRESTON RD #300
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City | FRISCO
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State | TX
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Zip | 75034-6320
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Country | US
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Telephone | 972-712-9000
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Fax | 972-712-1941
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Authorized Official
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Title or Position | OWNER
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Name | DR. CLYDE R LEE
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Credential | DDS
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Telephone | 972-712-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | 18959
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | 18285
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License Number State | TX
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