MEDICARE: DR. PHILIP LEE D.M.D.

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	6626	NV

General Provider Information

NPI Number	:	1538540380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP LEE D.M.D.

Provider Business Mailing Address
First Line	:	261 WATERTON LAKES AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-2800
Country	:	US
Telephone Number	:	702-810-3155
Fax Number	:

Provider Business Practice Location Address
First Line	:	5900 W CHEYENNE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-4203
Country	:	US
Telephone Number	:	702-674-7000
Fax Number	:

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

Provider Enumeration Date	:	06/17/2015
Last Update Date	:	03/17/2018

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