Active NPI
Samantha Lee, DDS
- Dentist
- Elkhart, IN
National Provider Identifier
1790395200
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 12013433A
- Practice address
- 125 S Nappanee St
Elkhart, IN 46514-1967 - Phone
- (574) 522-0156
- NPI assigned
- Aug 10, 2020
- Last updated
- Aug 10, 2020
- 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 | 12013433A | IN | Primary |
Addresses
Primary practice location
125 S Nappanee St
Elkhart, IN 46514-1967
Mailing address
12630 Union Rd
Culver, IN 46511-9776
Phone (574) 339-8626
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12013433A | IN | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Elkhart Dental Center PC | Dentist | Past | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1597017600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597017600000",
"number": "1790395200",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12630 UNION RD",
"city": "CULVER",
"state": "IN",
"postal_code": "465119776",
"telephone_number": "574-339-8626"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "125 S NAPPANEE ST",
"city": "ELKHART",
"state": "IN",
"postal_code": "465141967",
"telephone_number": "574-522-0156"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "SAMANTHA",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-08-10",
"last_updated": "2020-08-10",
"certification_date": "2020-08-10",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IN",
"license": "12013433A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elkhart, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.