Provider Demographics
NPI:1346817541
Name:LEE, NICOLE
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7120 WOODLAWN AVE NE APT 107
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-1428
Mailing Address - Country:US
Mailing Address - Phone:425-503-1012
Mailing Address - Fax:
Practice Address - Street 1:7120 WOODLAWN AVE NE APT 107
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-1428
Practice Address - Country:US
Practice Address - Phone:425-503-1012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-07
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY13468175411223P0221X
NJ22DI030046001223P0221X
WADE615655781223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric Dentistry