Provider Demographics
NPI:1720063696
Name:LEE, ABERT K (DDS)
Entity Type:Individual
Prefix:DR
First Name:ABERT
Middle Name:K
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 1:314 4TH AVE S
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-5836
Mailing Address - Country:US
Mailing Address - Phone:253-859-2111
Mailing Address - Fax:
Practice Address - Street 1:314 4TH AVE S
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-5836
Practice Address - Country:US
Practice Address - Phone:253-859-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA99871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA$$$$$$$$$OtherPLEASE LINK TIN WITH SSN