Provider Demographics
NPI:1659661957
Name:LEE, AMY GWENDOLYN (RDH)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:GWENDOLYN
Last Name:LEE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:GWENDOLYN
Other - Last Name:TOLEDO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:UNIT 38450
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96604-8450
Mailing Address - Country:US
Mailing Address - Phone:315-622-7539
Mailing Address - Fax:
Practice Address - Street 1:UNIT 38450
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96604-8450
Practice Address - Country:US
Practice Address - Phone:315-622-7539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist