Provider Demographics
NPI:1750719282
Name:DENNIS, LEE JAMES (ND)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:JAMES
Last Name:DENNIS
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12616 SE STARK ST
Mailing Address - Street 2:PLAZA 125, BUILDING L
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-1058
Mailing Address - Country:US
Mailing Address - Phone:503-408-0790
Mailing Address - Fax:503-408-0791
Practice Address - Street 1:12616 SE STARK ST
Practice Address - Street 2:PLAZA 125, BUILDING L
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-1058
Practice Address - Country:US
Practice Address - Phone:503-408-0790
Practice Address - Fax:503-408-0791
Is Sole Proprietor?:No
Enumeration Date:2013-10-18
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1987175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath