Provider Demographics
NPI:1346752953
Name:LEE, JOANETTE Y (RDH)
Entity Type:Individual
Prefix:
First Name:JOANETTE
Middle Name:Y
Last Name:LEE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14722 BALTIMORE AVE UNIT 103
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4873
Mailing Address - Country:US
Mailing Address - Phone:240-607-8515
Mailing Address - Fax:
Practice Address - Street 1:14722 BALTIMORE AVE UNIT 103
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4873
Practice Address - Country:US
Practice Address - Phone:240-607-8515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-04
Last Update Date:2017-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD6526124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist