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General NPI Number Information
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NPI Number | 1265273270
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Entity Type | Individual
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Provider Name | SOMANG LEE-THACKER DMD
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Gender | Female
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Dates
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Enumeration Date | 06/04/2024
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Last Update Date | 04/18/2025
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Provider Practice Location Address
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Address Line | 4707 COLUMBIA PIKE UNIT C1
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City | ARLINGTON
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State | VA
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Zip | 22204-5923
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Country | US
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Telephone | 703-705-4022
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Fax |
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Provider Business Mailing Address
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Address Line | 4101 FOUNTAINSIDE LN
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City | FAIRFAX
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State | VA
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Zip | 22030-6094
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Country | US
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Telephone | 502-802-1147
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401418880
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License Number State | VA
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