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General NPI Number Information
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NPI Number | 1073270336
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Entity Type | Individual
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Provider Name | MRS. CHAROLETTE B LEE
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Gender | Female
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Dates
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Enumeration Date | 11/22/2021
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Last Update Date | 11/22/2021
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Provider Practice Location Address
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Address Line | SALOMON DENTAL CLINIC 11TH AIRBORNE DIVISION ROAD
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City | FORT BENNING
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State | GA
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Zip | 31905
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Country | US
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Telephone | 706-544-9072
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Fax |
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Provider Business Mailing Address
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Address Line | 599 LAUREL RIDGE LN
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City | CATAULA
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State | GA
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Zip | 31804-2866
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Country | US
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Telephone | 706-566-3037
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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 | 126800000X
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Taxonomy Name | Dental Assistant
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License Number |
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License Number State |
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