Healthcare Provider Details

I. General information

NPI: 1356035422
Provider Name (Legal Business Name): JANE LEE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2023
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2328 W JOPPA RD STE 102
LUTHERVILLE TIMONIUM MD
21093-4668
US

IV. Provider business mailing address

2328 W JOPPA RD STE 102
LUTHERVILLE TIMONIUM MD
21093-4668
US

V. Phone/Fax

Practice location:
  • Phone: 410-296-8050
  • Fax:
Mailing address:
  • Phone: 410-296-8050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number18638
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: