MEDICARE: TERESA 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	1223G0001X	General Practice Dentistry	6821	NV

General Provider Information

NPI Number	:	1659825628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA LEE

Provider Business Mailing Address
First Line	:	6885 ALIANTE PKWY STE 111
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-5815
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6885 ALIANTE PKWY
Second Line	:	#111
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-5811
Country	:	US
Telephone Number	:	702-515-1888
Fax Number	:

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

Provider Enumeration Date	:	08/08/2016
Last Update Date	:	07/04/2021

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Directions to “ TERESA LEE ” Practice Location

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