Provider Demographics
NPI:1497729487
Name:LEE, SHANDRA C (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHANDRA
Middle Name:C
Last Name:LEE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:SHANDRA
Other - Middle Name:C
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:15180 N 104TH WAY
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-8570
Mailing Address - Country:US
Mailing Address - Phone:480-458-7968
Mailing Address - Fax:
Practice Address - Street 1:2217 W HAPPY VALLEY RD STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-1604
Practice Address - Country:US
Practice Address - Phone:623-581-7031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD65231223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics