MEDICARE: LEE&LEE HIRAM CLARK PLLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316253776
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEE&LEE HIRAM CLARK PLLC

Provider Business Mailing Address
First Line	:	10260 WESTHEIMER RD
Second Line	:	STE 390
City	:	HOUSTON
State	:	TX
Zip	:	77042-3110
Country	:	US
Telephone Number	:	713-977-5300
Fax Number	:	713-977-5348

Provider Business Practice Location Address
First Line	:	4407 W FUQUA ST # R
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77045-6256
Country	:	US
Telephone Number	:	713-434-7333
Fax Number	:	713-434-7334

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. EMILY LEE
Credential	:	DDS
Telephone Number	:	713-977-5300

Provider Enumeration Date	:	08/24/2010
Last Update Date	:	03/08/2011

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