1649284134 NPI number — DR. ROLLYN PAUL LEE DDS

Table of content: DR. ROLLYN PAUL LEE DDS (NPI 1649284134)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649284134 NPI number — DR. ROLLYN PAUL LEE DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEE
Provider First Name:
ROLLYN
Provider Middle Name:
PAUL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1649284134
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 106
Provider Second Line Business Mailing Address:
1030 RIVER PLACE DRIVE
Provider Business Mailing Address City Name:
AMERY
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-268-2103
Provider Business Mailing Address Fax Number:
715-268-7729

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1030 RIVER PLACE DRIVE
Provider Second Line Business Practice Location Address:
106
Provider Business Practice Location Address City Name:
AMERY
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54001-0106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-268-2103
Provider Business Practice Location Address Fax Number:
715-268-7729
Provider Enumeration Date:
07/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  4876015 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 122300000X , with the licence number: D9794 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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