Provider Demographics
NPI:1972601227
Name:LEE, CRAIG V (DDS)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:V
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 1:4020 SOUTH 700 EAST
Mailing Address - Street 2:SUITE #3
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107
Mailing Address - Country:US
Mailing Address - Phone:801-261-8056
Mailing Address - Fax:801-261-8060
Practice Address - Street 1:4020 SOUTH 700 EAST
Practice Address - Street 2:SUITE #3
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107
Practice Address - Country:US
Practice Address - Phone:801-261-8056
Practice Address - Fax:801-261-8060
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT137326-99211223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
T77970Medicare UPIN