Provider Demographics
NPI:1922364363
Name:LEE, ELL LOUIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELL
Middle Name:LOUIS
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 1:2361 LOST DAUPHIN RD
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-9165
Mailing Address - Country:US
Mailing Address - Phone:920-338-8373
Mailing Address - Fax:
Practice Address - Street 1:2361 LOST DAUPHIN RD
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-9165
Practice Address - Country:US
Practice Address - Phone:920-338-8373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5000059-151223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery