Provider Demographics
NPI:1952474132
Name:LEE, ANDY W (DDS)
Entity Type:Individual
Prefix:
First Name:ANDY
Middle Name:W
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 1:2900 S PEORIA ST STE A
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-3182
Mailing Address - Country:US
Mailing Address - Phone:303-368-3636
Mailing Address - Fax:303-368-3631
Practice Address - Street 1:2900 S PEORIA ST STE A
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-3182
Practice Address - Country:US
Practice Address - Phone:303-368-3636
Practice Address - Fax:303-368-3631
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9408122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO03257827Medicaid
CO86185756Medicaid