Provider Demographics
NPI:1316323082
Name:LEE, DEAN AND ANGHESOM, PLLC
Entity type:Organization
Organization Name:LEE, DEAN AND ANGHESOM, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-456-7621
Mailing Address - Street 1:2425 E HACIENDA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-1810
Mailing Address - Country:US
Mailing Address - Phone:702-456-7621
Mailing Address - Fax:702-456-7625
Practice Address - Street 1:2425 E HACIENDA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-1810
Practice Address - Country:US
Practice Address - Phone:702-456-7621
Practice Address - Fax:702-456-7625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty