Provider Demographics
NPI:1336571009
Name:KREGER, LEE BALDWIN (DDS)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:BALDWIN
Last Name:KREGER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4346 STARKEY RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-0605
Mailing Address - Country:US
Mailing Address - Phone:540-989-3321
Mailing Address - Fax:
Practice Address - Street 1:4346 STARKEY RD
Practice Address - Street 2:SUITE 3
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-0605
Practice Address - Country:US
Practice Address - Phone:540-989-3321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-05
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014144191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice