Provider Demographics
NPI:1881029593
Name:C LEA DMD PLLC
Entity Type:Organization
Organization Name:C LEA DMD PLLC
Other - Org Name:LYNNWOOD ENDODONTICS PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:425-672-3737
Mailing Address - Street 1:18631 ALDERWOOD MALL PKWY STE 203
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-8057
Mailing Address - Country:US
Mailing Address - Phone:425-627-3737
Mailing Address - Fax:
Practice Address - Street 1:18631 ALDERWOOD MALL PKWY STE 203
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-8057
Practice Address - Country:US
Practice Address - Phone:425-627-3737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE601901141223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty