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General NPI Number Information
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NPI Number | 1013692243
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Entity Type | Individual
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Provider Name | JENNA LEE DMD
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Gender | Female
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Dates
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Enumeration Date | 06/15/2023
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Last Update Date | 06/15/2023
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Provider Practice Location Address
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Address Line | 245 SMITHVILLE CHURCH RD
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City | WARNER ROBINS
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State | GA
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Zip | 31088-7803
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Country | US
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Telephone | 478-971-4799
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Fax |
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Provider Business Mailing Address
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Address Line | 116 BROOK HOLLOW CT
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City | KATHLEEN
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State | GA
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Zip | 31047-2795
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Country | US
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Telephone | 478-361-3259
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN123068
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License Number State | GA
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