Provider Demographics
NPI:1649284134
Name:LEE, ROLLYN PAUL (DDS)
Entity type:Individual
Prefix:DR
First Name:ROLLYN
Middle Name:PAUL
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:PO BOX 106
Mailing Address - Street 2:1030 RIVER PLACE DRIVE
Mailing Address - City:AMERY
Mailing Address - State:WI
Mailing Address - Zip Code:54001
Mailing Address - Country:US
Mailing Address - Phone:715-268-2103
Mailing Address - Fax:715-268-7729
Practice Address - Street 1:1030 RIVER PLACE DRIVE
Practice Address - Street 2:106
Practice Address - City:AMERY
Practice Address - State:WI
Practice Address - Zip Code:54001-0106
Practice Address - Country:US
Practice Address - Phone:715-268-2103
Practice Address - Fax:715-268-7729
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4876015122300000X
MND9794122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist