Provider Demographics
NPI:1174193122
Name:LEE, LILLA (DDS)
Entity Type:Individual
Prefix:
First Name:LILLA
Middle Name:
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 1:618 DENTAL CO/US ARMY DENTAC-KOREA
Mailing Address - Street 2:UNIT 15652
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96271
Mailing Address - Country:US
Mailing Address - Phone:253-968-4029
Mailing Address - Fax:
Practice Address - Street 1:618 DENTAL CO/US ARMY DENTAC-KOREA
Practice Address - Street 2:UNIT 15652
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96271
Practice Address - Country:US
Practice Address - Phone:253-968-4029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12335390-99211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice