Provider Demographics
NPI:1578831244
Name:VERNON G. LEE, D.D.S., PA
Entity Type:Organization
Organization Name:VERNON G. LEE, D.D.S., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:G
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:620-365-6262
Mailing Address - Street 1:415 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:IOLA
Mailing Address - State:KS
Mailing Address - Zip Code:66749-2352
Mailing Address - Country:US
Mailing Address - Phone:620-365-6262
Mailing Address - Fax:620-365-6866
Practice Address - Street 1:415 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:IOLA
Practice Address - State:KS
Practice Address - Zip Code:66749-2352
Practice Address - Country:US
Practice Address - Phone:620-365-6262
Practice Address - Fax:620-365-6866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-08
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45401223G0001X
KS606861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty