Individual
JESSICA P. LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
240 S 40TH ST, PHILADELPHIA, PA 19104-6030
(215) 898-0775
Mailing address
2400 CHESTNUT ST, APT. 1104, PHILADELPHIA, PA 19103-4316
(202) 365-0872
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS040006
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/18/2013
Last updated
10/01/2014
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