Provider Demographics
NPI:1881399954
Name:LEE, SAMWELL S (DDS)
Entity type:Individual
Prefix:DR
First Name:SAMWELL
Middle Name:S
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 1:1531 GEORGE DIETER DR APT 208
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-7665
Mailing Address - Country:US
Mailing Address - Phone:516-306-5953
Mailing Address - Fax:
Practice Address - Street 1:2260 N ZARAGOZA RD STE A112
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-8125
Practice Address - Country:US
Practice Address - Phone:915-308-1868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-30
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13842122300000X
TX40343122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist