Provider Demographics
NPI:1689972895
Name:LEE, CHRISTIE S (DDS)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:S
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 1:1729 ANALOG DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-1944
Mailing Address - Country:US
Mailing Address - Phone:972-437-0200
Mailing Address - Fax:972-437-0035
Practice Address - Street 1:1729 ANALOG DR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-1944
Practice Address - Country:US
Practice Address - Phone:972-437-0200
Practice Address - Fax:972-437-0035
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-11
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX150591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7377500001Medicare NSC