Provider Demographics
NPI:1124120274
Name:LEE, SHELLY LING-CHIN (DDS MS)
Entity type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:LING-CHIN
Last Name:LEE
Suffix:
Gender:F
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2000 EAST 116TH ST
Mailing Address - Street 2:STE 104
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-3581
Mailing Address - Country:US
Mailing Address - Phone:317-848-7778
Mailing Address - Fax:317-571-8368
Practice Address - Street 1:2000 EAST 116TH ST
Practice Address - Street 2:STE 104
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3581
Practice Address - Country:US
Practice Address - Phone:317-848-7778
Practice Address - Fax:317-571-8368
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010476131223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics