Herietta Lee

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

16884 Issued in MD

Practice address

196 Thomas Johnson Dr Ste 130
Frederick, MD 21702-4519

Phone

(301) 663-5552

NPI assigned

Apr 25, 2019

Last updated

Oct 13, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in DC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dentist

Education

University of Maryland at Baltimore School of Dentistry, 2019

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Community Clinic, Inc.

  dba CCI Health Services

  • Federally Qualified Health Center (FQHC)
  • Takoma Park, MD
  • NPI 1790730281

  DC

  Medicare reassignment
• Kids Dental Clinic

  • Dentist
  • Germantown, MD
  • NPI 1154281541
  NPD (past)
• R&S Dental LLC

  • General Practice Dentistry
  • Germantown, MD
  • NPI 1033075841
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1556150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665619200000",
    "number": "1750945788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10201 WASHINGTONIAN BLVD APT 429",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208788309",
            "telephone_number": "240-644-7779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "196 THOMAS JOHNSON DR STE 130",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217024519",
            "telephone_number": "301-663-5552"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20400 Observation Dr Ste 208",
            "address_purpose": "LOCATION",
            "city": "Germantown",
            "state": "MD",
            "postal_code": "208764087",
            "country_code": "US",
            "telephone_number": "301-528-8685",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEE",
        "first_name": "HERIETTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-04-25",
        "last_updated": "2022-10-13",
        "certification_date": "2022-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "16884",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NC",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Clara Ledman
• Lee Oncology, PA
• Arthur Lee
• Bryan Lee, PHMNP
• Gregory Brian Lee, L. AC
• Hyesoo Lee, DDS
• Jeffrey K Lee
• Jessica Lee
• Jian Lee, DDS
• Jim Ming-an Lee, MPH, DDS, MS

• General Practice Dentistry in Frederick, MD
• Providers in Frederick, MD by specialty
• General Practice Dentistry in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.