MEDICARE: SAMANTHA HOPE LEE

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	DB-2025-0193	NM
2	122300000X	Dentist	41522	TX
3	122300000X	Dentist	112223	CA

General Provider Information

NPI Number	:	1417843269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA HOPE LEE

Provider Business Mailing Address
First Line	:	705 E UNIVERSITY AVE STE B
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-5637
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	705 E UNIVERSITY AVE STE B
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-5637
Country	:	US
Telephone Number	:	575-386-5777
Fax Number	:

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

Provider Enumeration Date	:	06/17/2025
Last Update Date	:	08/25/2025

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Directions to “ SAMANTHA HOPE LEE ” Practice Location

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