MEDICARE: LEE & MILANI FAMILY DENTISTRY

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	261QD0000X	Dental Clinic/Center	28970	TX

General Provider Information

NPI Number	:	1447794607
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEE & MILANI FAMILY DENTISTRY

Provider Business Mailing Address
First Line	:	12311 NACOGDOCHES RD
Second Line	:	#107
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-2138
Country	:	US
Telephone Number	:	210-656-7600
Fax Number	:	210-656-7660

Provider Business Practice Location Address
First Line	:	12311 NACOGDOCHES RD
Second Line	:	#107
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-2138
Country	:	US
Telephone Number	:	210-656-7600
Fax Number	:	210-656-7660

Authorized Official
Title or Position	:	DENTIST/MANAGING MEMBER
Name	:	DR. NAMHEE LEE
Credential	:	D.D.S.
Telephone Number	:	210-656-7600

Provider Enumeration Date	:	12/07/2016
Last Update Date	:	12/07/2016

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