Provider Demographics
NPI:1730362237
Name:LEE, AMY Z (DMD MSD PHD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:Z
Last Name:LEE
Suffix:
Gender:F
Credentials:DMD MSD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 N CREST BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-1846
Mailing Address - Country:US
Mailing Address - Phone:478-757-5826
Mailing Address - Fax:478-757-5823
Practice Address - Street 1:152 N CREST BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-1846
Practice Address - Country:US
Practice Address - Phone:478-757-5826
Practice Address - Fax:478-757-5823
Is Sole Proprietor?:No
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0130741223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics