Provider Demographics
NPI:1629168075
Name:LEE, STEVEN RAYNOND (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:RAYNOND
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 DUVALL AVE NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-3975
Mailing Address - Country:US
Mailing Address - Phone:425-271-6002
Mailing Address - Fax:425-271-6314
Practice Address - Street 1:1620 DUVALL AVE NE
Practice Address - Street 2:SUITE A
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98059-3975
Practice Address - Country:US
Practice Address - Phone:425-271-6002
Practice Address - Fax:425-271-6314
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000054511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice