1124334586 NPI number — LEE & LEE CULLEN

Table of content: (NPI 1124334586)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124334586 NPI number — LEE & LEE CULLEN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEE & LEE CULLEN
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CROWN DENTAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124334586
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10260 WESTHEIMER RD
Provider Second Line Business Mailing Address:
STE 390
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77042-3110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-977-5300
Provider Business Mailing Address Fax Number:
713-977-5348

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12805 CULLEN BLVD
Provider Second Line Business Practice Location Address:
STE E
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77047-3759
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-264-7333
Provider Business Practice Location Address Fax Number:
713-264-7336
Provider Enumeration Date:
08/24/2010

Additional Information

Authorized Official

Authorized Official Last Name:
LEE
Authorized Official First Name:
EMILY
Authorized Official Middle Name:
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
713-264-7333

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1999716-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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