Individual
HERIETTA LEE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
196 THOMAS JOHNSON DR STE 130, FREDERICK, MD 21702-4519
(301) 663-5552
Mailing address
10201 WASHINGTONIAN BLVD APT 429, GAITHERSBURG, MD 20878-8309
(240) 644-7779
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
16884
MD
390200000X
Student in an Organized Health Care Education/Training Program
—
NC
Other
Enumeration date
04/25/2019
Last updated
10/13/2022
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