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General NPI Number Information
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NPI Number | 1619397387
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Entity Type | Organization
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Legal Business Name | LEE FAMILY DENTISTRY, PA
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Dates
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Enumeration Date | 04/22/2014
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Last Update Date | 04/22/2014
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Provider Practice Location Address
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Address Line | 133 N CENTER ST
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City | SENATOBIA
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State | MS
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Zip | 38668-2130
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Country | US
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Telephone | 662-562-9609
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Fax | 662-562-4169
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Provider Business Mailing Address
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Address Line | 133 N CENTER ST
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City | SENATOBIA
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State | MS
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Zip | 38668-2130
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Country | US
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Telephone | 662-562-9609
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Fax | 662-562-4169
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. PRESTON HUGH LEE III
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Credential | D.D.S.
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Telephone | 662-562-9609
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 3577-10
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License Number State | MS
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