Provider Demographics
NPI:1558436014
Name:RO-LEE, SUNG-A ELIZABETH (DMD)
Entity type:Individual
Prefix:DR
First Name:SUNG-A
Middle Name:ELIZABETH
Last Name:RO-LEE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 128TH ST SW
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-6319
Mailing Address - Country:US
Mailing Address - Phone:425-347-7722
Mailing Address - Fax:425-347-7723
Practice Address - Street 1:621 128TH ST SW
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-6319
Practice Address - Country:US
Practice Address - Phone:425-347-7722
Practice Address - Fax:425-347-7723
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000103851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5051198Medicaid
BR8098914OtherDEA