Individual
JESSICA LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
125 S NAPPANEE ST, ELKHART, IN 46514-1967
(574) 522-0156
Mailing address
12630 UNION RD, CULVER, IN 46511-9776
(574) 339-8627
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12013809A
IN
Other
Enumeration date
07/19/2022
Last updated
07/19/2022
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