Provider Demographics
NPI:1275042194
Name:MCLEE, LATESHA MONIQUE (RDH)
Entity Type:Individual
Prefix:
First Name:LATESHA
Middle Name:MONIQUE
Last Name:MCLEE
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 1:3915 BLACKBURN LN APT 43
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-1226
Mailing Address - Country:US
Mailing Address - Phone:724-880-2596
Mailing Address - Fax:
Practice Address - Street 1:1401 ROCKVILLE PIKE FL 3
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1428
Practice Address - Country:US
Practice Address - Phone:240-777-1879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-22
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD5509124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist