MEDICARE: SHANNON LEE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	00206051	CO

General Provider Information

NPI Number	:	1043058662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON LEE DDS

Provider Business Mailing Address
First Line	:	11019 E 25TH DR
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80010-1216
Country	:	US
Telephone Number	:	409-594-5124
Fax Number	:

Provider Business Practice Location Address
First Line	:	9250 E HAMPDEN AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80231-5413
Country	:	US
Telephone Number	:	303-930-8888
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2024
Last Update Date	:	07/17/2024

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Directions to “ SHANNON LEE DDS” Practice Location

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