MEDICARE: DR. ANGIE LEE DMD, MS

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	8277	NC
2	122300000X	Dentist	2901020133	MI
3	1223P0300X	Periodontics	DN1855725	MA
4	1223P0300X	Periodontics	DEN00201944	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972656338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGIE LEE DMD, MS

Provider Business Mailing Address
First Line	:	1220 OAK PARK DR
Second Line	:	SUITE 110
City	:	FORT COLLINS
State	:	CO
Zip	:	80525
Country	:	US
Telephone Number	:	970-999-5126
Fax Number	:	970-999-5928

Provider Business Practice Location Address
First Line	:	1220 OAK PARK DR
Second Line	:	SUITE 110
City	:	FORT COLLINS
State	:	CO
Zip	:	80525
Country	:	US
Telephone Number	:	970-999-5126
Fax Number	:	970-999-5928

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

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	03/04/2015

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