Healthcare Provider Details

I. General information

NPI: 1558804575
Provider Name (Legal Business Name): DAVID B LEE DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2016
Last Update Date: 04/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 UNIVERSITY BLVD W SUITE G4
SILVER SPRING MD
20902-3351
US

IV. Provider business mailing address

1111 UNIVERSITY BLVD W SUITE G4
SILVER SPRING MD
20902-3351
US

V. Phone/Fax

Practice location:
  • Phone: 301-649-5001
  • Fax: 301-681-8132
Mailing address:
  • Phone: 301-649-5001
  • Fax: 301-681-8132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number11816
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. DAVID B LEE
Title or Position: OWNER
Credential: D.D.S.
Phone: 301-649-5001