NPIMap

Organization Active NPI

Lee MLK Dental Group, PC

  • General Practice Dentistry
  • N Las Vegas, NV
National Provider Identifier
1952497984
Registry record updated May 7, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
LEE MLK DENTAL GROUP, PC
Practice address
3896 N Martin Luther King Blvd
N Las Vegas, NV 89032-6603
Phone
(702) 614-1792
Fax
(702) 933-0190
NPI assigned
Oct 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 7, 2015

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

Authorized official

Name
Dr. Shannon K Lee, DMD
Title
Owner
Phone
(702) 614-1792

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

3896 N Martin Luther King Blvd
N Las Vegas, NV 89032-6603

Mailing address

17000 Red Hill Ave
Irvine, CA 92614-5626
Phone (714) 845-8890

Other names 1

  • Alexander Dental Group and Orthodontics Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
29D2263875Alexander Dental Group and Orthodontics3896 N Martin Luther King Blvd, N Las Vegas, NV 89032Certificate of waiverJul 5, 2026

National Provider Directory

National Provider Directory

Locations

3896 N Martin L King Blvd
North Las Vegas, NV 89032
Phone (702) 614-1792

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430956800000",
    "number": "1952497984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17000 RED HILL AVE",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926145626",
            "telephone_number": "714-845-8890",
            "fax_number": "949-474-1495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3896 N MARTIN LUTHER KING BLVD",
            "city": "N LAS VEGAS",
            "state": "NV",
            "postal_code": "890326603",
            "telephone_number": "702-614-1792",
            "fax_number": "702-933-0190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEE MLK DENTAL GROUP, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-05",
        "last_updated": "2015-05-07",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "702-614-1792",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Alexander Dental Group and Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in N 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 Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.