Provider Demographics
NPI:1497729487
Name:LEE, SHANDRA C (DMD)
Entity type:Individual
Prefix:DR
First Name:SHANDRA
Middle Name:C
Last Name:LEE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:SHANDRA
Other - Middle Name:C
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:4580 LOST CREEK LN
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-2576
Mailing Address - Country:US
Mailing Address - Phone:480-458-7968
Mailing Address - Fax:
Practice Address - Street 1:130 S 15TH ST STE 101
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4569
Practice Address - Country:US
Practice Address - Phone:360-428-4393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60965131223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics