Provider Demographics
NPI:1750440624
Name:LEE, DAVID W (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
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 1:5431 S RAINBOW BLVD STE C3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-1864
Mailing Address - Country:US
Mailing Address - Phone:702-647-6453
Mailing Address - Fax:702-873-7654
Practice Address - Street 1:5431 S RAINBOW BLVD STE C3
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-1864
Practice Address - Country:US
Practice Address - Phone:702-647-6453
Practice Address - Fax:702-873-7654
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV35281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice