Provider Demographics
NPI:1811022007
Name:LEE, VANESSA J (DMD)
Entity type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:J
Last Name: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 1:5971 W. US HIGHWAY 52
Mailing Address - Street 2:SUITE I
Mailing Address - City:NEW PALESTINE
Mailing Address - State:IN
Mailing Address - Zip Code:46163
Mailing Address - Country:US
Mailing Address - Phone:317-861-5000
Mailing Address - Fax:
Practice Address - Street 1:5971 W US HIGHWAY 52
Practice Address - Street 2:SUITE I
Practice Address - City:NEW PALESTINE
Practice Address - State:IN
Practice Address - Zip Code:46163-9486
Practice Address - Country:US
Practice Address - Phone:317-861-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009955122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200225010AMedicaid