Healthcare Provider Details

I. General information

NPI: 1285544536
Provider Name (Legal Business Name): ENDOEXCELC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13890 BRADDOCK RD STE 300
CENTREVILLE VA
20121-2438
US

IV. Provider business mailing address

13890 BRADDOCK RD STE 300
CENTREVILLE VA
20121-2438
US

V. Phone/Fax

Practice location:
  • Phone: 703-642-3900
  • Fax:
Mailing address:
  • Phone: 703-642-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: WONHEE LEE
Title or Position: PRESIDENT
Credential: DDS, MS
Phone: 202-826-5134