Provider Demographics
NPI:1083136675
Name:LEE, JENNIFER YOFONG (DMD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:YOFONG
Last Name:LEE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8630 FENTON ST STE 708
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3812
Mailing Address - Country:US
Mailing Address - Phone:240-839-5100
Mailing Address - Fax:
Practice Address - Street 1:8630 FENTON ST STE 708
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3812
Practice Address - Country:US
Practice Address - Phone:240-839-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD164391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice