Provider Demographics
NPI:1285799742
Name:LEES, JUDY A (RDHAP)
Entity type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:A
Last Name:LEES
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5753 HWY 85 NORTH
Mailing Address - Street 2:#2713
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-8823
Mailing Address - Country:US
Mailing Address - Phone:909-744-2752
Mailing Address - Fax:
Practice Address - Street 1:2675 VIKING LANE
Practice Address - Street 2:
Practice Address - City:RUNNING SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92382-1535
Practice Address - Country:US
Practice Address - Phone:909-744-2752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDHAP 159124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist