Provider Demographics
NPI:1144541095
Name:LEE, JESSICA JINHEE (DDS)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:JINHEE
Last Name:LEE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:JINHEE
Other - Last Name:LEE HERTIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:111 CHAMBERS HILL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-7304
Mailing Address - Country:US
Mailing Address - Phone:717-709-7922
Mailing Address - Fax:717-261-4915
Practice Address - Street 1:111 CHAMBERS HILL DR STE 202
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-7304
Practice Address - Country:US
Practice Address - Phone:717-709-7941
Practice Address - Fax:717-217-1941
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.000106621223P0221X
ALD.6440C1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO67188362Medicaid