Provider Demographics
NPI:1245217447
Name:LEE, DONG S (DMD)
Entity Type:Individual
Prefix:DR
First Name:DONG
Middle Name:S
Last Name:LEE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7734 ELMWOOD RD
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-2503
Mailing Address - Country:US
Mailing Address - Phone:617-388-7393
Mailing Address - Fax:
Practice Address - Street 1:25 CROSSROADS DR STE 147
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5485
Practice Address - Country:US
Practice Address - Phone:410-363-7090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21059122300000X
MD139641223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist