Brent D Lee, D.D.S., M.S.
Dentist, Oral and Maxillofacial Surgery in Pocatello, ID. Individual provider (NPI-1).
NPI number1154495802
StatusActive
Last updated in NPPESJul 8, 2007
Details
- NPI
- 1154495802
- Entity type
- Individual (NPI-1)
- Name
- Brent D Lee
- Credential
- D.D.S., M.S.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Nov 17, 2006
- Last updated
- Jul 8, 2007
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223S0112X | Dentist, Oral and Maxillofacial Surgery | d1494 | ID | Yes |
Practice location
165 N 14th AvePocatello, ID 83201-4146
Phone 208-232-2807 · Fax 208-232-8118
Mailing address
Po Box 6033165 N 14th Ave
Pocatello, ID 83205-6033
Phone 208-232-2807 · Fax 208-232-8118
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
Other Oral and Maxillofacial Surgery (Dentist) providers in Pocatello, ID
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