Provider Demographics
NPI:1588789408
Name:LEE DENTAL CENTERS
Entity type:Organization
Organization Name:LEE DENTAL CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-681-5555
Mailing Address - Street 1:6336 BANDERA RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-1604
Mailing Address - Country:US
Mailing Address - Phone:210-681-5555
Mailing Address - Fax:210-681-7121
Practice Address - Street 1:6336 BANDERA RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-1604
Practice Address - Country:US
Practice Address - Phone:210-681-5555
Practice Address - Fax:210-681-7121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX009630701Medicaid
TX009629901Medicaid
TX009631501Medicaid
TX009627301Medicaid
TX009632301Medicaid