MEDICARE: DR. ADRIAN DUDLEY LEE DMD

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	6299	NV

General Provider Information

NPI Number	:	1295082253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADRIAN DUDLEY LEE DMD

Provider Business Mailing Address
First Line	:	640 E DEER SPRINGS WAY
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89086-1512
Country	:	US
Telephone Number	:	702-399-3800
Fax Number	:

Provider Business Practice Location Address
First Line	:	640 E DEER SPRINGS WAY
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89086-1512
Country	:	US
Telephone Number	:	702-399-3800
Fax Number	:

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

Provider Enumeration Date	:	08/09/2012
Last Update Date	:	02/27/2013

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