Provider Demographics
NPI:1104570506
Name:KIM LEE, ELISA (DDS)
Entity type:Individual
Prefix:DR
First Name:ELISA
Middle Name:
Last Name:KIM LEE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7985 WADSWORTH BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80003-2111
Mailing Address - Country:US
Mailing Address - Phone:303-209-2250
Mailing Address - Fax:
Practice Address - Street 1:7985 WADSWORTH BLVD STE B
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-2111
Practice Address - Country:US
Practice Address - Phone:303-209-2280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-05
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002049801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice