Kelly Lee

Primary specialty

DentistTaxonomy code 122300000X

License

D010082 Issued in AZ

Practice address

12080 N Dove Mountain Blvd Ste 140
Marana, AZ 85658-4553

Phone

(520) 367-2742

NPI assigned

Jul 11, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Tera L Depaoli, DMD, LLC

  dba DePaoli Dentistry

  • General Practice Dentistry
  • Gibsonia, PA
  • NPI 1639747686
  NPD
• Rita Ranch Dental Group, LLP

  • General Practice Dentistry
  • Tucson, AZ
  • NPI 1386871564
  NPD (past)

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

{
    "created_epoch": "1531267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661299200000",
    "number": "1134615339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12080 N DOVE MOUNTAIN BLVD STE 140",
            "city": "MARANA",
            "state": "AZ",
            "postal_code": "856584553",
            "telephone_number": "520-367-2742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12080 N DOVE MOUNTAIN BLVD STE 140",
            "city": "MARANA",
            "state": "AZ",
            "postal_code": "856584553",
            "telephone_number": "520-367-2742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "KELLY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-11",
        "last_updated": "2022-08-24",
        "certification_date": "2022-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "D010082",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diana Kathleen Knipp, RN
• Tracey Lee Kruse, C.O.T.A.
• Rachel Lacy, SLPA
• Anna Margaret Laluzerne, MS, CF-SLP
• Bradner J Lawrence, DDS
• Legacy Hearts Care Services LLC Co
• Nicholas Lehan, DO
• Meagan Louise Lilly, OTR/L
• Angelee Crystal Lizarraga, RN, SANE-A
• Stefanie Lockery

• Dentist in Marana, AZ
• Providers in Marana, AZ by specialty
• Dentist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.