Active NPI
Shannon Kelly Lee, D.M.D.
- Dentist
- North Las Vegas, NV
National Provider Identifier
1649602152
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 6446
- Practice address
- 3896 N MLK Blvd
North Las Vegas, NV 89032-6603 - Phone
- (702) 614-1792
- Fax
- (702) 933-0190
- NPI assigned
- Aug 7, 2013
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 6446 | NV | Primary |
Addresses
Primary practice location
3896 N MLK Blvd
North Las Vegas, NV 89032-6603
Mailing address
3896 N MLK Blvd
North Las Vegas, NV 89032-6603
Phone (702) 614-1792
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NV
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150902002967 | NV | Order and Referring Only - Dentist | 4284940487 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6446 | NV | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1375833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1430956800000",
"number": "1649602152",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3896 N MLK BLVD",
"city": "NORTH LAS VEGAS",
"state": "NV",
"postal_code": "890326603",
"telephone_number": "702-614-1792",
"fax_number": "702-933-0190"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3896 N MLK BLVD",
"city": "NORTH LAS VEGAS",
"state": "NV",
"postal_code": "890326603",
"telephone_number": "702-614-1792",
"fax_number": "702-933-0190"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "SHANNON",
"middle_name": "KELLY",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-08-07",
"last_updated": "2015-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NV",
"license": "6446",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2015; 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.