Healthcare Provider Details

I. General information

NPI: 1417879321
Provider Name (Legal Business Name): NOVA DENTAL WORKS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6130 REDWOOD SQUARE CTR STE A
CENTREVILLE VA
20121-2636
US

IV. Provider business mailing address

6130 REDWOOD SQUARE CTR STE A
CENTREVILLE VA
20121-2636
US

V. Phone/Fax

Practice location:
  • Phone: 571-713-3210
  • Fax:
Mailing address:
  • Phone: 571-713-3210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PAUL HAN JU LEE
Title or Position: CEO, HEAD DENTIST
Credential: DDS
Phone: 571-713-3210