MEDICARE: CHARLES 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	1223G0001X	General Practice Dentistry	08790	IA
2	1223G0001X	General Practice Dentistry	NV6813	NV

General Provider Information

NPI Number	:	1306143847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES LEE DDS

Provider Business Mailing Address
First Line	:	7477 W LAKE MEAD BLVD
Second Line	:	STE 106
City	:	LAS VEGAS
State	:	NV
Zip	:	89128
Country	:	US
Telephone Number	:	702-737-6080
Fax Number	:	702-804-5349

Provider Business Practice Location Address
First Line	:	7477 W LAKE MEAD BLVD
Second Line	:	STE 106
City	:	LAS VEGAS
State	:	NV
Zip	:	89128
Country	:	US
Telephone Number	:	702-737-6080
Fax Number	:	702-804-5349

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

Provider Enumeration Date	:	02/18/2011
Last Update Date	:	11/14/2016

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Directions to “ CHARLES LEE DDS” Practice Location

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