MEDICARE: ALEASIA ANN 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	13697	NC

General Provider Information

NPI Number	:	1497481899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEASIA ANN LEE DMD

Provider Business Mailing Address
First Line	:	2554 LEWISVILLE CLEMMONS RD STE 104
Second Line	:
City	:	CLEMMONS
State	:	NC
Zip	:	27012-8749
Country	:	US
Telephone Number	:	336-860-7106
Fax Number	:

Provider Business Practice Location Address
First Line	:	2554 LEWISVILLE CLEMMONS RD STE 104
Second Line	:
City	:	CLEMMONS
State	:	NC
Zip	:	27012-8749
Country	:	US
Telephone Number	:	336-860-7106
Fax Number	:

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

Provider Enumeration Date	:	07/27/2022
Last Update Date	:	04/26/2026

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