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General NPI Number Information
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NPI Number | 1710004601
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Entity Type | Individual
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Provider Name | BENJAMIN K LEE D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 13880 BRADDOCK RD SUITE 109
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City | CENTREVILLE
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State | VA
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Zip | 20121-2459
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Country | US
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Telephone | 703-830-9990
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Fax |
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Provider Business Mailing Address
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Address Line | 13880 BRADDOCK RD SUITE 109
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City | CENTREVILLE
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State | VA
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Zip | 20121-2459
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Country | US
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Telephone | 703-830-9990
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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 | 7961
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License Number State | VA
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