Provider Demographics
NPI:1376613414
Name:LEE, CARYN H (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARYN
Middle Name:H
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 1:10238 E HAMPTON AVE #105
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85208
Mailing Address - Country:US
Mailing Address - Phone:480-986-2600
Mailing Address - Fax:480-986-4164
Practice Address - Street 1:10238 E HAMPTON AVE #105
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85208
Practice Address - Country:US
Practice Address - Phone:480-986-2600
Practice Address - Fax:480-986-4164
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD66271223G0001X
AZ6627122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist