Provider Demographics
NPI:1124046271
Name:LEE, JAMES EARL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:EARL
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-4823
Mailing Address - Country:US
Mailing Address - Phone:843-248-4115
Mailing Address - Fax:843-248-6145
Practice Address - Street 1:611 CHURCH ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-4823
Practice Address - Country:US
Practice Address - Phone:843-248-4115
Practice Address - Fax:843-248-6145
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8995201Medicaid
SCZ16439Medicaid
NC881-716OtherUNITED CONCORDIA PROV.