Individual provider Active NPI

Wyatt T Lee, DDS

  • General Practice Dentistry
  • Seattle, WA
National Provider Identifier
1578766267
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DE00004764 Issued in WA
Practice address
1001 Broadway
Suite 307
Seattle, WA 98122-4399
Phone
(206) 328-2280
Fax
(206) 328-2494
NPI assigned
Jun 8, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DE00004764 WA Primary

Addresses

Primary practice location

1001 Broadway
Suite 307
Seattle, WA 98122-4399

Mailing address

1001 Broadway
Suite 307
Seattle, WA 98122-4399
Phone (206) 328-2280

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20161219000412 WA Order and Referring Only - DentistPractitioner - Dentist 0446530018

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DE00004764WAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Wyatt T. Lee DDS PLLC General Practice PastSince Aug 30, 2020 Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1181260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1578766267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 BROADWAY",
            "address_2": "SUITE 307",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981224399",
            "telephone_number": "206-328-2280",
            "fax_number": "206-328-2494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 BROADWAY",
            "address_2": "SUITE 307",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981224399",
            "telephone_number": "206-328-2280",
            "fax_number": "206-328-2494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "WYATT",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE00004764",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.