Provider Demographics
NPI:1568024115
Name:LEE, KRISTIN LAUREN (DDS)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:LAUREN
Last Name:LEE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98-1247 KAAHUMANU ST STE 314
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-5301
Mailing Address - Country:US
Mailing Address - Phone:808-375-1005
Mailing Address - Fax:
Practice Address - Street 1:98-1247 KAAHUMANU ST STE 314
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-5301
Practice Address - Country:US
Practice Address - Phone:808-375-1005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-03
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1037731223S0112X
HIDT-28671223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery