Provider Demographics
NPI:1316022734
Name:LEE, PAUL MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MICHAEL
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3975 FAIR RIDGE DR
Mailing Address - Street 2:NORTH BUILDING SUITE #305
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2911
Mailing Address - Country:US
Mailing Address - Phone:703-352-9600
Mailing Address - Fax:703-352-7160
Practice Address - Street 1:3975 FAIR RIDGE DR
Practice Address - Street 2:NORTH BUILDING SUITE #305
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-2911
Practice Address - Country:US
Practice Address - Phone:703-352-9600
Practice Address - Fax:703-352-7160
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010077021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice