Healthcare Provider Details

I. General information

NPI: 1982516787
Provider Name (Legal Business Name): DAVID LEE DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12506 LAKE RIDGE DR STE B
WOODBRIDGE VA
22192-2397
US

IV. Provider business mailing address

5509 QUAIL CT
CLIFTON VA
20124-0903
US

V. Phone/Fax

Practice location:
  • Phone: 571-572-3445
  • Fax:
Mailing address:
  • Phone: 919-601-5088
  • 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: DAVID SUNGKU LEE
Title or Position: OWNER
Credential: DDS
Phone: 919-601-5088