Provider Demographics
NPI:1760545115
Name:LEE, MICHAEL WAYNE II (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WAYNE
Last Name:LEE
Suffix:II
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 NORTHWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2424
Mailing Address - Country:US
Mailing Address - Phone:678-923-8000
Mailing Address - Fax:
Practice Address - Street 1:711 NORTHWOOD CIR
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2424
Practice Address - Country:US
Practice Address - Phone:678-923-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN012135122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000944391AMedicaid
FLDN18529OtherSTATE OF FLORIDA DENTAL LICENSE
GADN012135OtherDENTAL LICENSE