Provider Demographics
NPI:1558804575
Name:DAVID B LEE DDS PA
Entity Type:Organization
Organization Name:DAVID B LEE DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-649-5001
Mailing Address - Street 1:1111 UNIVERSITY BLVD W
Mailing Address - Street 2:SUITE G4
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-3351
Mailing Address - Country:US
Mailing Address - Phone:301-649-5001
Mailing Address - Fax:301-681-8132
Practice Address - Street 1:1111 UNIVERSITY BLVD W
Practice Address - Street 2:SUITE G4
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-3351
Practice Address - Country:US
Practice Address - Phone:301-649-5001
Practice Address - Fax:301-681-8132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-22
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11816332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment