MEDICARE: LEE & VAN MIEGHEM DDS PLLC

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

General Provider Information

NPI Number	:	1740326735
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEE & VAN MIEGHEM DDS PLLC

Provider Business Mailing Address
First Line	:	19718 68TH AVE W
Second Line	:	SUITE G
City	:	LYNNWOOD
State	:	WA
Zip	:	98036-5965
Country	:	US
Telephone Number	:	425-778-6677
Fax Number	:	425-774-1258

Provider Business Practice Location Address
First Line	:	19718 68TH AVE W
Second Line	:	SUITE G
City	:	LYNNWOOD
State	:	WA
Zip	:	98036-5965
Country	:	US
Telephone Number	:	425-778-6677
Fax Number	:	425-774-1258

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. STEPHEN R LEE
Credential	:	D.D.S.
Telephone Number	:	425-778-6677

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	08/22/2020

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