MEDICARE: VINCENT 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	122300000X	Dentist	0401006194	VA

General Provider Information

NPI Number	:	1497838080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINCENT LEE DDS

Provider Business Mailing Address
First Line	:	5881 LEESBURG PIKE
Second Line	:	SUITE 502
City	:	BAILEYS CROSSROADS
State	:	VA
Zip	:	22041-2312
Country	:	US
Telephone Number	:	703-820-4646
Fax Number	:	703-820-7278

Provider Business Practice Location Address
First Line	:	5881 LEESBURG PIKE
Second Line	:	SUITE 502
City	:	BAILEYS CROSSROADS
State	:	VA
Zip	:	22041-2312
Country	:	US
Telephone Number	:	703-820-4646
Fax Number	:	703-820-7278

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	07/08/2007

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