Provider Demographics
NPI:1992870182
Name:LEE, QUYEN T (DDS)
Entity type:Individual
Prefix:DR
First Name:QUYEN
Middle Name:T
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 1:121 N 31ST ST STE A
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504-2453
Mailing Address - Country:US
Mailing Address - Phone:254-231-4948
Mailing Address - Fax:254-231-4930
Practice Address - Street 1:121 N 31ST ST STE A
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-2453
Practice Address - Country:US
Practice Address - Phone:254-231-4948
Practice Address - Fax:254-231-4930
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23047122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice