Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 8197 | AZ |
Y | 1223P0300X | Periodontist | D008197 | AZ |
NPI | 1093000150 |
---|---|
Provider Name | Dr. Spencer Matthew Lee |
First Address | Wright-Patterson Afb, OH 45433 |
Second Address | Wright-Patterson Afb, OH 45433 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2011 |
Last Update Date | 06/05/2021 |