Provider Demographics
NPI:1164096749
Name:LEE REDDITT DMD, PLLC
Entity Type:Organization
Organization Name:LEE REDDITT DMD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:G
Authorized Official - Last Name:UNDERWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-653-1300
Mailing Address - Street 1:5721 HIGHWAY 90 STE A
Mailing Address - Street 2:
Mailing Address - City:THEODORE
Mailing Address - State:AL
Mailing Address - Zip Code:36582-3601
Mailing Address - Country:US
Mailing Address - Phone:251-653-1242
Mailing Address - Fax:
Practice Address - Street 1:5721 HIGHWAY 90 STE A
Practice Address - Street 2:
Practice Address - City:THEODORE
Practice Address - State:AL
Practice Address - Zip Code:36582-3601
Practice Address - Country:US
Practice Address - Phone:251-653-1242
Practice Address - Fax:251-653-1242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental