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General NPI Number Information
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NPI Number | 1154904837
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Entity Type | Organization
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Legal Business Name | FONTES LEE PLLC
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Dates
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Enumeration Date | 04/30/2021
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Last Update Date | 04/30/2021
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Provider Practice Location Address
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Address Line | 4229 LAFAYETTE CENTER DR STE 1400
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City | CHANTILLY
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State | VA
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Zip | 20151-1267
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Country | US
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Telephone | 703-378-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 4229 LAFAYETTE CENTER DR STE 1400
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City | CHANTILLY
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State | VA
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Zip | 20151-1267
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Country | US
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Telephone | 734-645-5820
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Fax |
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Authorized Official
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Title or Position | PEDIATRIC DENTIST
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Name | ATTN: FERNANDA G FONTES
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Credential | DDS
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Telephone | 734-645-5820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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