Provider Demographics
NPI:1114015948
Name:LEE, SOO YUN STACY (DDS)
Entity Type:Individual
Prefix:
First Name:SOO YUN
Middle Name:STACY
Last Name:LEE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3400 BRINKLEY RD
Mailing Address - Street 2:#201
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-7105
Mailing Address - Country:US
Mailing Address - Phone:301-870-4553
Mailing Address - Fax:301-870-7034
Practice Address - Street 1:10665 STANHAVEN PL
Practice Address - Street 2:STE 105
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695-3060
Practice Address - Country:US
Practice Address - Phone:301-632-5480
Practice Address - Fax:301-870-7034
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD136741223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics