Active NPI
Michael B Lee, DDS. MS
- Periodontics
- Prescott, AZ
National Provider Identifier
1306063250
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 9599
- Practice address
- 1000 Willow Creek Rd Ste H
Prescott, AZ 86301-1645 - Phone
- (928) 693-7000
- Fax
- (928) 693-7005
- NPI assigned
- Apr 20, 2007
- Last updated
- Jul 21, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 9599 | AZ | Primary |
Addresses
Primary practice location
1000 Willow Creek Rd Ste H
Prescott, AZ 86301-1645
Mailing address
1000 Willow Creek Rd Ste H
Prescott, AZ 86301-1645
Phone (928) 693-7000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jun 24, 2016 through Jun 24, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9599 | AZ | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1306063250",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1000 WILLOW CREEK RD STE H",
"city": "PRESCOTT",
"state": "AZ",
"postal_code": "863011645",
"telephone_number": "928-693-7000",
"fax_number": "928-693-7005"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 WILLOW CREEK RD STE H",
"city": "PRESCOTT",
"state": "AZ",
"postal_code": "863011645",
"telephone_number": "928-693-7000",
"fax_number": "928-693-7005"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "MICHAEL",
"middle_name": "B",
"name_prefix": "Dr.",
"credential": "DDS. MS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-20",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "AZ",
"license": "9599",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Prescott, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.