Provider Demographics
NPI:1568097236
Name:LEE PLAZA DENTAL LLC
Entity Type:Organization
Organization Name:LEE PLAZA DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER AND SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:WING
Authorized Official - Middle Name:MANN
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-201-2645
Mailing Address - Street 1:4320 WORNALL RD STE 446
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-3235
Mailing Address - Country:US
Mailing Address - Phone:816-376-0851
Mailing Address - Fax:
Practice Address - Street 1:4320 WORNALL RD STE 446
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3235
Practice Address - Country:US
Practice Address - Phone:816-376-0851
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental