Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 04834 | AZ |
NPI | 1013550375 |
---|---|
Provider Name | Shawn Lee |
First Address | Oro Valley, AZ 85755-1628 |
Second Address | Tucson, AZ 85745-2819 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2019 |
Last Update Date | 18/10/2019 |