Provider Demographics
NPI:1780009407
Name:MICHAEL LEE DDS PLLC
Entity Type:Organization
Organization Name:MICHAEL LEE DDS PLLC
Other - Org Name:EASTSIDE KIDS DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTACT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-968-2840
Mailing Address - Street 1:8630 164TH AVE NE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3606
Mailing Address - Country:US
Mailing Address - Phone:425-968-2840
Mailing Address - Fax:
Practice Address - Street 1:8630 164TH AVE NE
Practice Address - Street 2:STE 202
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3606
Practice Address - Country:US
Practice Address - Phone:425-968-2840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-04
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE6021630261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2024262Medicaid