Provider Demographics
NPI:1629455209
Name:LEE, EUGENIA (DMD, MSD)
Entity Type:Individual
Prefix:
First Name:EUGENIA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18115 68TH AVE NE STE C104
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-3010
Mailing Address - Country:US
Mailing Address - Phone:485-486-5033
Mailing Address - Fax:425-402-3788
Practice Address - Street 1:18115 68TH AVE NE STE C104
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028-3010
Practice Address - Country:US
Practice Address - Phone:485-486-5033
Practice Address - Fax:425-402-3788
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-02
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE600225461223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics