Provider Demographics
NPI:1538414578
Name:LEE, LAUREN-NIKKO (DDS)
Entity type:Individual
Prefix:
First Name:LAUREN-NIKKO
Middle Name:
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 1:4701 183A TOLL RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7227
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4701 183A TOLL RD
Practice Address - Street 2:SUITE C
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7227
Practice Address - Country:US
Practice Address - Phone:512-593-7998
Practice Address - Fax:512-717-3396
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-16
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX278881223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry