Individual provider Active NPI

Khayla Rasheede Lee, DDS

  • Pediatric Dentistry
  • Spring Lake, NC
National Provider Identifier
1073356267
Registry record updated Jul 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
14878 Issued in NC
Practice address
2980 Ray Rd
Spring Lake, NC 28390-7801
Phone
(910) 778-8485
NPI assigned
Jun 14, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 22, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X 14878 NC Primary
Pediatric Dentistry 1223P0221X DGD.10835 SC

Addresses

Primary practice location

2980 Ray Rd
Spring Lake, NC 28390-7801

Mailing address

2980 Ray Rd
Spring Lake, NC 28390-7801
Phone (910) 778-8485

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240826001455 SC Order and Referring Only - DentistPractitioner - Dentist 3274072020

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DGD.10835SCMDPediatric Dentist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1718323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784678400000",
    "number": "1073356267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2980 RAY RD",
            "city": "SPRING LAKE",
            "state": "NC",
            "postal_code": "283907801",
            "telephone_number": "910-778-8485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2980 RAY RD",
            "city": "SPRING LAKE",
            "state": "NC",
            "postal_code": "283907801",
            "telephone_number": "910-778-8485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "KHAYLA",
        "middle_name": "RASHEEDE",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-06-14",
        "last_updated": "2026-07-22",
        "certification_date": "2026-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NC",
            "license": "14878",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "SC",
            "license": "DGD.10835",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Spring Lake, NC

Sources for this page

Verify at the official NPI Registry.