Provider Demographics
NPI:1851592422
Name:LEE, MARY RUTH (RDH)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:RUTH
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 1:141 WILDER DR
Mailing Address - Street 2:
Mailing Address - City:FORSYTH
Mailing Address - State:GA
Mailing Address - Zip Code:31029-2911
Mailing Address - Country:US
Mailing Address - Phone:478-994-5997
Mailing Address - Fax:
Practice Address - Street 1:155 COLLEGE ST
Practice Address - Street 2:SUITE 2
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-7206
Practice Address - Country:US
Practice Address - Phone:478-741-3688
Practice Address - Fax:478-741-0912
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007253124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist