Provider Demographics
NPI:1376995779
Name:LINCICOME, LEE (RDH)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:
Last Name:LINCICOME
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 S MARYLAND PKWY
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-3230
Mailing Address - Country:US
Mailing Address - Phone:702-575-0866
Mailing Address - Fax:
Practice Address - Street 1:2100 S MARYLAND PKWY
Practice Address - Street 2:SUITE 5
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-3230
Practice Address - Country:US
Practice Address - Phone:702-575-0866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-08
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3293124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist