Provider Demographics
NPI:1205980737
Name:LEE, WALTER M (DDS)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:M
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 1:11311 BRIDGEPORT WAY SW STE 303
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-3078
Mailing Address - Country:US
Mailing Address - Phone:253-588-8000
Mailing Address - Fax:253-589-2835
Practice Address - Street 1:11311 BRIDGEPORT WAY SW STE 303
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3078
Practice Address - Country:US
Practice Address - Phone:253-588-8000
Practice Address - Fax:253-589-2835
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA69261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice