| NPI | 1326260936 |
|---|---|
| Former Name | KELLEY ANNE LEE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401411377) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 13618) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2015-05-28 |