Healthcare Provider Details

I. General information

NPI: 1023953908
Provider Name (Legal Business Name): BALTIMORE ENDODONTIC ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8601 LASALLE RD STE 203
TOWSON MD
21286-2004
US

IV. Provider business mailing address

8 SAGEWOOD CT
SPARKS GLENCOE MD
21152-9304
US

V. Phone/Fax

Practice location:
  • Phone: 443-794-4108
  • Fax:
Mailing address:
  • Phone: 443-794-4108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. HEEJUN K LEE
Title or Position: ENDODONTIST
Credential: DDS
Phone: 443-794-4108