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General NPI Number Information
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NPI Number | 1215272430
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Entity Type | Individual
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Provider Name | SUNG-EUN LEE MARSHALL D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 11/28/2012
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Last Update Date | 05/19/2022
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Provider Practice Location Address
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Address Line | 10210 W MCDOWELL RD STE 140
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City | AVONDALE
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State | AZ
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Zip | 85392-4844
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Country | US
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Telephone | 480-564-4981
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Fax |
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Provider Business Mailing Address
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Address Line | 204 N BRONCO CIR
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City | PAYSON
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State | AZ
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Zip | 85541-4297
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Country | US
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Telephone | 323-616-5996
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 28539
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D011286
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License Number State | AZ
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