MEDICARE: JARED DAVID LEE DMD

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	1223P0221X	Pediatric Dentistry	27301	TX

General Provider Information

NPI Number	:	1669740759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JARED DAVID LEE DMD

Provider Business Mailing Address
First Line	:	10003 NW MILITARY HWY STE 3201
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78231-1892
Country	:	US
Telephone Number	:	210-417-4181
Fax Number	:

Provider Business Practice Location Address
First Line	:	10003 NW MILITARY HWY STE 3201
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78231-1892
Country	:	US
Telephone Number	:	210-417-4181
Fax Number	:

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

Provider Enumeration Date	:	12/05/2011
Last Update Date	:	08/06/2019

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Directions to “ JARED DAVID LEE DMD” Practice Location

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