Healthcare Provider Details

I. General information

NPI: 1275042194
Provider Name (Legal Business Name): LATESHA MONIQUE MCLEE RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2017
Last Update Date: 09/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 ROCKVILLE PIKE FL 3
ROCKVILLE MD
20852-1428
US

IV. Provider business mailing address

3915 BLACKBURN LN APT 43
BURTONSVILLE MD
20866-1226
US

V. Phone/Fax

Practice location:
  • Phone: 240-777-1879
  • Fax:
Mailing address:
  • Phone: 724-880-2596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number5509
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: