Provider Demographics
NPI:1992085724
Name:LI, JEAN
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8724 SNOWHILL CT
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-4411
Mailing Address - Country:US
Mailing Address - Phone:617-840-4323
Mailing Address - Fax:
Practice Address - Street 1:1212 NEW YORK AVE NW STE 430
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005-3987
Practice Address - Country:US
Practice Address - Phone:202-735-0719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010293331223P0300X
MD155431223P0300X
DCDEN10013201223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics