Provider Demographics
NPI:1043474158
Name:EMILY LEE DDS PC
Entity type:Organization
Organization Name:EMILY LEE DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EVP & CHIEF STRATEGY AND GROWTH
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:DEMBERECKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-571-2140
Mailing Address - Street 1:685 E PRATER WAY
Mailing Address - Street 2:SUITE #103
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-4681
Mailing Address - Country:US
Mailing Address - Phone:775-358-4600
Mailing Address - Fax:775-358-4660
Practice Address - Street 1:685 E PRATER WAY
Practice Address - Street 2:SUITE #103
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-4681
Practice Address - Country:US
Practice Address - Phone:775-358-4600
Practice Address - Fax:775-358-4660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty