MEDICARE: HYESOO LEE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	19065	MD

General Provider Information

NPI Number	:	1346098720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HYESOO LEE DDS

Provider Business Mailing Address
First Line	:	555 STANTON ST APT 216
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21701-7742
Country	:	US
Telephone Number	:	410-208-8653
Fax Number	:

Provider Business Practice Location Address
First Line	:	5960 FREDERICK CROSSING LN
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21704-5164
Country	:	US
Telephone Number	:	302-662-2160
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2024
Last Update Date	:	06/09/2026

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Directions to “ HYESOO LEE DDS” Practice Location

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