Provider Demographics
NPI:1306392428
Name:LEE, SARANG (DMD)
Entity Type:Individual
Prefix:
First Name:SARANG
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 S RURAL RD
Mailing Address - Street 2:#2S
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-2435
Mailing Address - Country:US
Mailing Address - Phone:480-447-1906
Mailing Address - Fax:
Practice Address - Street 1:2525 S RURAL RD
Practice Address - Street 2:#2S
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-2435
Practice Address - Country:US
Practice Address - Phone:480-447-1906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9566122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist