MEDICARE: DR. PAUL MICHAEL LEE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	0401007702	VA

General Provider Information

NPI Number	:	1316022734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL MICHAEL LEE DDS

Provider Business Mailing Address
First Line	:	3975 FAIR RIDGE DR
Second Line	:	NORTH BUILDING SUITE #305
City	:	FAIRFAX
State	:	VA
Zip	:	22033-2911
Country	:	US
Telephone Number	:	703-352-9600
Fax Number	:	703-352-7160

Provider Business Practice Location Address
First Line	:	3975 FAIR RIDGE DR
Second Line	:	NORTH BUILDING SUITE #305
City	:	FAIRFAX
State	:	VA
Zip	:	22033-2911
Country	:	US
Telephone Number	:	703-352-9600
Fax Number	:	703-352-7160

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	06/30/2011

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