Provider Demographics
NPI:1447210919
Name:LEE, KYRA D (DMD)
Entity Type:Individual
Prefix:DR
First Name:KYRA
Middle Name:D
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 1:2715 W NORTHERN AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-6641
Mailing Address - Country:US
Mailing Address - Phone:602-995-0280
Mailing Address - Fax:602-864-9161
Practice Address - Street 1:2715 W NORTHERN AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-6641
Practice Address - Country:US
Practice Address - Phone:602-995-0280
Practice Address - Fax:602-864-9161
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ55791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice