Provider Demographics
NPI:1366877250
Name:LEE, KOURTNEY ADELE (DDS)
Entity type:Individual
Prefix:MRS
First Name:KOURTNEY
Middle Name:ADELE
Last Name:LEE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KOURTNEY
Other - Middle Name:ADELE
Other - Last Name:SIMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:MIDSHORE PEDIATRIC DENTISTRY
Mailing Address - Street 2:508-B CYNWOOD DR
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601
Mailing Address - Country:US
Mailing Address - Phone:410-819-0726
Mailing Address - Fax:410-810-3239
Practice Address - Street 1:MIDSHORE PEDIATRIC DENTISTRY
Practice Address - Street 2:508-B CYNWOOD DR
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601
Practice Address - Country:US
Practice Address - Phone:410-819-0726
Practice Address - Fax:410-810-3239
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-10
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9756122300000X, 1223P0221X
MD178401223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist