MEDICARE: JOANETTE Y LEE RDH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	6526	MD

General Provider Information

NPI Number	:	1346752953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANETTE Y LEE RDH

Provider Business Mailing Address
First Line	:	14722 BALTIMORE AVE UNIT 103
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20707-4873
Country	:	US
Telephone Number	:	240-607-8515
Fax Number	:

Provider Business Practice Location Address
First Line	:	14722 BALTIMORE AVE UNIT 103
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20707-4873
Country	:	US
Telephone Number	:	240-607-8515
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2017
Last Update Date	:	11/04/2017

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Directions to “ JOANETTE Y LEE RDH” Practice Location

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