Provider Demographics
NPI:1710010012
Name:LEE, THOMAS H (DDS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:H
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14221 E 4TH AVE
Mailing Address - Street 2:STE 222
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-8735
Mailing Address - Country:US
Mailing Address - Phone:303-344-1227
Mailing Address - Fax:303-344-1827
Practice Address - Street 1:14221 E 4TH AVE STE 222
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-8721
Practice Address - Country:US
Practice Address - Phone:303-344-1227
Practice Address - Fax:303-344-1827
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO92641223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO870778605OtherTAX ID