Provider Demographics
NPI:1750128450
Name:LEE, ERICKA RENEE (DDS)
Entity type:Individual
Prefix:
First Name:ERICKA
Middle Name:RENEE
Last Name:LEE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4141 FRISCO GREEN AVE APT 127
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-2335
Mailing Address - Country:US
Mailing Address - Phone:479-871-1536
Mailing Address - Fax:
Practice Address - Street 1:15950 ELDORADO PKWY STE 100
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-5816
Practice Address - Country:US
Practice Address - Phone:972-540-9977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40551122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist