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General NPI Number Information
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NPI Number | 1518270180
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Entity Type | Organization
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Legal Business Name | RICHARD LEE DMD PC
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Dates
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Enumeration Date | 07/23/2010
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Last Update Date | 03/21/2024
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Provider Practice Location Address
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Address Line | 19465 DEERFIELD AVE STE 304
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City | LANSDOWNE
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State | VA
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Zip | 20176-1705
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Country | US
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Telephone | 703-858-0303
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Fax |
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Provider Business Mailing Address
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Address Line | 19465 DEERFIELD AVE STE 304
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City | LANSDOWNE
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State | VA
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Zip | 20176-1705
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Country | US
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Telephone | 703-858-0303
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICHARD JOHN LEE
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Credential | DMD
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Telephone | 703-858-0303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 0401412280
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License Number State | VA
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