Provider Demographics
NPI:1215011424
Name:DAHL, LEE A (DDS)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:A
Last Name:DAHL
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 1:114 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:NE
Mailing Address - Zip Code:68745-0488
Mailing Address - Country:US
Mailing Address - Phone:402-256-3231
Mailing Address - Fax:402-256-9535
Practice Address - Street 1:114 E 2ND ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:NE
Practice Address - Zip Code:68745-0488
Practice Address - Country:US
Practice Address - Phone:402-256-3231
Practice Address - Fax:402-256-9535
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE44481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025365600Medicaid
NE5690OtherBCBS OF NE