Provider Demographics
NPI:1659531283
Name:LEE, ENA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ENA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2715 MARSHALL CT
Mailing Address - Street 2:203
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-2255
Mailing Address - Country:US
Mailing Address - Phone:651-216-7073
Mailing Address - Fax:
Practice Address - Street 1:3230 UNIVERSITY AVE
Practice Address - Street 2:STE 11
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-3540
Practice Address - Country:US
Practice Address - Phone:608-231-1718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12521122300000X
WI6294-015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist