Healthcare Provider Details

I. General information

NPI: 1518118413
Provider Name (Legal Business Name): LEE & OH DDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2008
Last Update Date: 02/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25055 RIDING PLZ SUITE 250
SOUTH RIDING VA
20152-5917
US

IV. Provider business mailing address

25055 RIDING PLZ SUITE 250
SOUTH RIDING VA
20152-5917
US

V. Phone/Fax

Practice location:
  • Phone: 703-327-7705
  • Fax: 703-327-0472
Mailing address:
  • Phone: 703-327-7705
  • Fax: 703-327-0472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number0401007799
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number401410902
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number0401414044
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6141
License Number StateVA

VIII. Authorized Official

Name: MS. NICOLE K SEATON
Title or Position: PRACTICE MANAGER
Credential:
Phone: 703-327-7705