MEDICARE: LEE MARTIN, PC

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	1223G0001X	General Practice Dentistry	6061	NV
2	1223G0001X	General Practice Dentistry	4702	NV
3	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	S226	NV
4	1223G0001X	General Practice Dentistry	3749	NV

General Provider Information

NPI Number	:	1114220878
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEE MARTIN, PC

Provider Business Mailing Address
First Line	:	1471 N JONES BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-1610
Country	:	US
Telephone Number	:	702-851-6722
Fax Number	:	702-636-0678

Provider Business Practice Location Address
First Line	:	1471 N JONES BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-1610
Country	:	US
Telephone Number	:	702-851-6722
Fax Number	:	702-636-0678

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	DR. ROBIN DONG LEE
Credential	:	DDS
Telephone Number	:	702-851-6722

Provider Enumeration Date	:	12/17/2010
Last Update Date	:	12/17/2010

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