Provider Demographics
NPI:1245540897
Name:GLORIA M LEE, DDS, PC
Entity type:Organization
Organization Name:GLORIA M LEE, DDS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-519-3455
Mailing Address - Street 1:11904 DARNESTOWN RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-3202
Mailing Address - Country:US
Mailing Address - Phone:301-519-3455
Mailing Address - Fax:301-947-2746
Practice Address - Street 1:11904 DARNESTOWN RD
Practice Address - Street 2:SUITE A
Practice Address - City:NORTH POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20878-3202
Practice Address - Country:US
Practice Address - Phone:301-519-3455
Practice Address - Fax:301-947-2746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD136601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty