Provider Demographics
NPI:1982681011
Name:LEE, BRUCE W (DDS)
Entity type:Individual
Prefix:DR
First Name:BRUCE
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 1:3175 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:THATCHER
Mailing Address - State:AZ
Mailing Address - Zip Code:85552-5667
Mailing Address - Country:US
Mailing Address - Phone:720-244-9337
Mailing Address - Fax:
Practice Address - Street 1:795 S 20TH AVE
Practice Address - Street 2:
Practice Address - City:SAFFORD
Practice Address - State:AZ
Practice Address - Zip Code:85546-3322
Practice Address - Country:US
Practice Address - Phone:928-428-2750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0116971223G0001X
CO1063501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice