MEDICARE: TIFFANY KAFEI LEE DDS

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	1223P0700X	Prosthodontics	63003	CA
2	1223P0700X	Prosthodontics	S5-46C	NV

General Provider Information

NPI Number	:	1932645827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY KAFEI LEE DDS

Provider Business Mailing Address
First Line	:	2345 E CENTENNIAL PKWY STE 110
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-5605
Country	:	US
Telephone Number	:	702-991-0404
Fax Number	:

Provider Business Practice Location Address
First Line	:	2345 E CENTENNIAL PKWY STE 110
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-5605
Country	:	US
Telephone Number	:	702-991-0404
Fax Number	:	702-991-0404

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

Provider Enumeration Date	:	01/16/2017
Last Update Date	:	11/29/2017

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Directions to “ TIFFANY KAFEI LEE DDS” Practice Location

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