MEDICARE: DAVID B LEE DDS PA

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	332BC3200X	Customized Equipment (DME)

General Provider Information

NPI Number	:	1386152320
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID B LEE DDS PA

Provider Business Mailing Address
First Line	:	9256 BENDIX RD STE 202
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-1848
Country	:	US
Telephone Number	:	410-461-6655
Fax Number	:

Provider Business Practice Location Address
First Line	:	9256 BENDIX RD STE 202
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-1848
Country	:	US
Telephone Number	:	410-461-6655
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID LEE
Credential	:	DDS
Telephone Number	:	410-461-6655

Provider Enumeration Date	:	01/11/2018
Last Update Date	:	01/11/2018

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