Provider Demographics
NPI:1619397387
Name:LEE FAMILY DENTISTRY, PA
Entity Type:Organization
Organization Name:LEE FAMILY DENTISTRY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRESTON
Authorized Official - Middle Name:HUGH
Authorized Official - Last Name:LEE
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:662-562-9609
Mailing Address - Street 1:133 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:SENATOBIA
Mailing Address - State:MS
Mailing Address - Zip Code:38668-2130
Mailing Address - Country:US
Mailing Address - Phone:662-562-9609
Mailing Address - Fax:662-562-4169
Practice Address - Street 1:133 N CENTER ST
Practice Address - Street 2:
Practice Address - City:SENATOBIA
Practice Address - State:MS
Practice Address - Zip Code:38668-2130
Practice Address - Country:US
Practice Address - Phone:662-562-9609
Practice Address - Fax:662-562-4169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3577-10122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty