Provider Demographics
NPI:1740591924
Name:LEE, AMANDA R (DDS)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:R
Last Name:LEE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:LEE
Other - Last Name:SEIDL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:310 MILLSTONE DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278
Mailing Address - Country:US
Mailing Address - Phone:919-296-8584
Mailing Address - Fax:919-296-1016
Practice Address - Street 1:310 MILLSTONE DR
Practice Address - Street 2:SUITE 1
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278
Practice Address - Country:US
Practice Address - Phone:919-296-8584
Practice Address - Fax:919-296-1016
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN100351223P0221X
NC89571223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry