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General NPI Number Information
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NPI Number | 1568097236
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Entity Type | Organization
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Legal Business Name | LEE PLAZA DENTAL LLC
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Dates
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Enumeration Date | 03/03/2020
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Last Update Date | 03/03/2020
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Provider Practice Location Address
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Address Line | 4320 WORNALL RD STE 446
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City | KANSAS CITY
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State | MO
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Zip | 64111-3235
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Country | US
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Telephone | 816-376-0851
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Fax |
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Provider Business Mailing Address
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Address Line | 4320 WORNALL RD STE 446
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City | KANSAS CITY
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State | MO
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Zip | 64111-3235
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Country | US
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Telephone | 816-376-0851
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Fax |
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Authorized Official
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Title or Position | MANAGER AND SOLE MEMBER
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Name | DR. WING MANN LEE
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Credential | DMD
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Telephone | 617-201-2645
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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