Provider Demographics
NPI:1558438366
Name:LEE, JODICE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JODICE
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JODICE
Other - Middle Name:
Other - Last Name:LEE-BELISLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2130 W POPLAR AVE SUITE 106
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017
Mailing Address - Country:US
Mailing Address - Phone:901-861-7007
Mailing Address - Fax:901-861-7066
Practice Address - Street 1:2130 W POPLAR AVE SUITE 106
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017
Practice Address - Country:US
Practice Address - Phone:901-861-7007
Practice Address - Fax:901-861-7066
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN83091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice