Healthcare Provider Details

I. General information

NPI: 1346098720
Provider Name (Legal Business Name): HYESOO LEE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2024
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5960 FREDERICK CROSSING LN
FREDERICK MD
21704-5164
US

IV. Provider business mailing address

555 STANTON ST APT 216
FREDERICK MD
21701-7742
US

V. Phone/Fax

Practice location:
  • Phone: 302-662-2160
  • Fax:
Mailing address:
  • Phone: 410-208-8653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number19065
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: