Healthcare Provider Details

I. General information

NPI: 1922987320
Provider Name (Legal Business Name): JESSICA LEE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2025
Last Update Date: 08/29/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

674 BLVD DE FRANCE
PARRIS ISLAND SC
29905
US

IV. Provider business mailing address

MCRD PARRIS ISLAND DENTAL BLDG 674 BLVD DE FRANCE
PARRIS ISLAND SC
29905
US

V. Phone/Fax

Practice location:
  • Phone: 843-228-3500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number18687
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: