Healthcare Provider Details

I. General information

NPI: 1467081422
Provider Name (Legal Business Name): JIAN LEE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 SAINT JOHNS CHURCH RD
CAMP HILL PA
17011-4049
US

IV. Provider business mailing address

2100 OLD FARM DR STE 1E
FREDERICK MD
21702-9494
US

V. Phone/Fax

Practice location:
  • Phone: 717-253-9839
  • Fax:
Mailing address:
  • Phone: 301-631-5970
  • Fax: 301-631-6805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number062494
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS042954
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS042954
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number19063
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: