Provider Demographics
NPI:1457462772
Name:LEE FAMILY DENTISTRY
Entity Type:Organization
Organization Name:LEE FAMILY DENTISTRY
Other - Org Name:LEE COSMETIC & FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANC
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-561-0522
Mailing Address - Street 1:11753 WEST BELLFORT STREET
Mailing Address - Street 2:SUITE 116
Mailing Address - City:STAFFOR
Mailing Address - State:TX
Mailing Address - Zip Code:77477-1327
Mailing Address - Country:US
Mailing Address - Phone:281-561-0522
Mailing Address - Fax:281-561-7890
Practice Address - Street 1:11753 WEST BELLFORT STREET
Practice Address - Street 2:SUITE 116
Practice Address - City:STAFFOR
Practice Address - State:TX
Practice Address - Zip Code:77477-1327
Practice Address - Country:US
Practice Address - Phone:281-561-0522
Practice Address - Fax:281-561-7890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14535122300000X
TX14416122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87D943OtherBLUE CROSS
TX789759OtherUNITED CONCORDIA
TX87D942OtherBLUE SHIELD