MEDICARE: THOMAS G. LEE, D.D.S., INC.

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	9337	TX

General Provider Information

NPI Number	:	1497838957
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS G. LEE, D.D.S., INC.

Provider Business Mailing Address
First Line	:	PO BOX 188
Second Line	:	104 WEST POWELL DRIVE
City	:	WILLIS
State	:	TX
Zip	:	77378-0188
Country	:	US
Telephone Number	:	936-856-4582
Fax Number	:	936-856-7074

Provider Business Practice Location Address
First Line	:	104 WEST POWELL DRIVE
Second Line	:
City	:	WILLIS
State	:	TX
Zip	:	77378-0188
Country	:	US
Telephone Number	:	936-856-4582
Fax Number	:	936-856-7074

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. THOMAS G. LEE
Credential	:	D.D.S.
Telephone Number	:	936-856-4582

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	08/22/2020

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