Provider Demographics
NPI:1073270336
Name:LEE, CHAROLETTE B
Entity Type:Individual
Prefix:MRS
First Name:CHAROLETTE
Middle Name:B
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:599 LAUREL RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:CATAULA
Mailing Address - State:GA
Mailing Address - Zip Code:31804-2866
Mailing Address - Country:US
Mailing Address - Phone:706-566-3037
Mailing Address - Fax:
Practice Address - Street 1:SALOMON DENTAL CLINIC
Practice Address - Street 2:11TH AIRBORNE DIVISION ROAD
Practice Address - City:FORT BENNING
Practice Address - State:GA
Practice Address - Zip Code:31905
Practice Address - Country:US
Practice Address - Phone:706-544-9072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant