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General NPI Number Information
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NPI Number | 1003259631
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Entity Type | Individual
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Provider Name | JIM MING-AN LEE MPH, DDS, MS
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Gender | Male
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Dates
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Enumeration Date | 04/13/2013
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Last Update Date | 04/13/2013
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Provider Practice Location Address
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Address Line | 7360 GUILFORD DR STE #102
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City | FREDERICK
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State | MD
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Zip | 21704-5124
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Country | US
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Telephone | 301-668-2662
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Fax |
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Provider Business Mailing Address
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Address Line | 20002 FARMINGDALE CT
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City | HAGERSTOWN
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State | MD
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Zip | 21742-4055
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Country | US
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Telephone | 202-423-8867
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 15259
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License Number State | MD
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