Michael J Lee, DDS

Key facts

NPI

1356016901

Entity type

Individual (NPI type 1)

Primary specialty

General Practice Dentistry 1223G0001X

License

D1327 (SD)

Practice address

112 N 2ND Ave W # 57626
Faith, SD 57626-6086

Phone

(605) 967-2644

NPI assigned

Aug 14, 2021

Sex

Male

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 14, 2021.

{
    "created_epoch": "1628899200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628899200000",
    "number": "1356016901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 N 2ND AVE W # 57626",
            "city": "FAITH",
            "state": "SD",
            "postal_code": "576266086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 N 2ND AVE W # 57626",
            "city": "FAITH",
            "state": "SD",
            "postal_code": "576266086",
            "telephone_number": "605-967-2644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "MICHAEL",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-14",
        "last_updated": "2021-08-14",
        "certification_date": "2021-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SD",
            "license": "D1327",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Faith, SD · General Practice Dentistry in South Dakota