Provider Demographics
NPI:1932103645
Name:LEE, SHERYL (DMD)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 SE 160TH AVE
Mailing Address - Street 2:STE 121
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-8910
Mailing Address - Country:US
Mailing Address - Phone:360-253-3480
Mailing Address - Fax:360-253-3484
Practice Address - Street 1:700 SE 160TH AVE
Practice Address - Street 2:STE 121
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-8910
Practice Address - Country:US
Practice Address - Phone:360-253-3480
Practice Address - Fax:360-253-3484
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE7945122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist