Provider Demographics
NPI:1689254641
Name:RODEMS, LEE E
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:E
Last Name:RODEMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 SMITH TOWNSHIP STATE RD
Mailing Address - Street 2:
Mailing Address - City:BURGETTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15021-2828
Mailing Address - Country:US
Mailing Address - Phone:304-293-2841
Mailing Address - Fax:
Practice Address - Street 1:1227 SMITH TOWNSHIP STATE RD
Practice Address - Street 2:
Practice Address - City:BURGETTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15021-2828
Practice Address - Country:US
Practice Address - Phone:724-947-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PADS043597122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program