Provider Demographics
NPI:1972585107
Name:ROUNDY, LEE E (DMD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:E
Last Name:ROUNDY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:867 S 1750 W
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-8235
Mailing Address - Country:US
Mailing Address - Phone:435-695-0478
Mailing Address - Fax:
Practice Address - Street 1:1001 SHADOW LN # MS 7423
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4124
Practice Address - Country:US
Practice Address - Phone:435-695-0478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5529129-99211223G0001X
UT5529129-99231223P0221X
NVS6-194C1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice