MEDICARE: DAVID D LEE DDS LLC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1659087369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID D LEE DDS LLC

Provider Business Mailing Address
First Line	:	7761 CRYSTAL BROOK WAY
Second Line	:
City	:	HANOVER
State	:	MD
Zip	:	21076-1869
Country	:	US
Telephone Number	:	410-971-0265
Fax Number	:

Provider Business Practice Location Address
First Line	:	9141 BALTIMORE NATIONAL PIKE
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-3935
Country	:	US
Telephone Number	:	410-465-1868
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ DOCTOR
Name	:	DR. DAVID LEE
Credential	:	DDS
Telephone Number	:	410-465-1868

Provider Enumeration Date	:	01/25/2023
Last Update Date	:	01/25/2023

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