Provider Demographics
NPI:1497838957
Name:THOMAS G. LEE, D.D.S., INC.
Entity Type:Organization
Organization Name:THOMAS G. LEE, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:936-856-4582
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:104 WEST POWELL DRIVE
Mailing Address - City:WILLIS
Mailing Address - State:TX
Mailing Address - Zip Code:77378-0188
Mailing Address - Country:US
Mailing Address - Phone:936-856-4582
Mailing Address - Fax:936-856-7074
Practice Address - Street 1:104 WEST POWELL DRIVE
Practice Address - Street 2:
Practice Address - City:WILLIS
Practice Address - State:TX
Practice Address - Zip Code:77378-0188
Practice Address - Country:US
Practice Address - Phone:936-856-4582
Practice Address - Fax:936-856-7074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX93371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty