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General NPI Number Information
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NPI Number | 1245856749
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Entity Type | Organization
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Legal Business Name | JLEE DENTAL CLINIC, PLLC
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Dates
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Enumeration Date | 06/19/2020
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Last Update Date | 06/19/2020
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Provider Practice Location Address
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Address Line | 416 S BETHLEHEM PIKE
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City | FORT WASHINGTON
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State | PA
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Zip | 19034-3418
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Country | US
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Telephone | 267-279-9271
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Fax |
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Provider Business Mailing Address
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Address Line | 28 ADDISON LN
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City | MALVERN
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State | PA
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Zip | 19355-1943
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JIWOO LEE
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Credential |
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Telephone | 267-279-9271
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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 |
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License Number State |
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