=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316450943
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEATHER S. LEE, DDS, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2017
-----------------------------------------------------
Last Update Date | 11/06/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 506 PARK HILL CT STE 3
-----------------------------------------------------
City | HENDERSONVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28739-4333
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-692-8939
-----------------------------------------------------
Fax | 828-697-7338
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 506 PARK HILL CT STE 3
-----------------------------------------------------
City | HENDERSONVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28739-4333
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-692-8939
-----------------------------------------------------
Fax | 828-697-7338
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | HEATHER LEE
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 828-692-8939
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 9219
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------