Basic Information
| Provider Information | |||||||||
| NPI: | 1407087570 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | LEAH | ||||||||
| MiddleName: | GORDON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 916 | ||||||||
| Address2: | |||||||||
| City: | LINDEN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370960916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9315892104 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7723 CLEARVIEW CHURCH LN | ||||||||
| Address2: | |||||||||
| City: | LYLES | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370981674 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9316705520 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2009 | ||||||||
| LastUpdateDate: | 04/17/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 9003 | TN | Y | Dental Providers | Dentist | General Practice |
No ID Information.