Provider Demographics
NPI:1841170438
Name:LEE, NATHAN H (DDS)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:H
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:PSC 313 BOX 2569
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96260-0026
Mailing Address - Country:US
Mailing Address - Phone:010-445-9376
Mailing Address - Fax:
Practice Address - Street 1:BUILDING S-180
Practice Address - Street 2:USADC CARROLL #15748
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96260
Practice Address - Country:US
Practice Address - Phone:315-737-9479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-04
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14226302-99261223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice