Provider Demographics
NPI:1235339466
Name:LEE, SORA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SORA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9038 ROYAL ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-1765
Mailing Address - Country:US
Mailing Address - Phone:703-415-6922
Mailing Address - Fax:866-855-1914
Practice Address - Street 1:11230 WAPLES MILL RD
Practice Address - Street 2:160
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6087
Practice Address - Country:US
Practice Address - Phone:703-691-2221
Practice Address - Fax:703-691-3215
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014115891223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics