Provider Demographics
NPI:1659002863
Name:LEE, KATELYN STOREY (DMD)
Entity Type:Individual
Prefix:DR
First Name:KATELYN
Middle Name:STOREY
Last Name:LEE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 CONFEDERATE AVE
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-2826
Mailing Address - Country:US
Mailing Address - Phone:704-754-3701
Mailing Address - Fax:
Practice Address - Street 1:115 BROWN ST # 102
Practice Address - Street 2:
Practice Address - City:GRANITE QUARRY
Practice Address - State:NC
Practice Address - Zip Code:28146-5108
Practice Address - Country:US
Practice Address - Phone:704-279-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-19
Last Update Date:2022-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12823122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist