Provider Demographics
NPI:1497838080
Name:LEE, VINCENT (DDS)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5881 LEESBURG PIKE
Mailing Address - Street 2:SUITE 502
Mailing Address - City:BAILEYS CROSSROADS
Mailing Address - State:VA
Mailing Address - Zip Code:22041-2312
Mailing Address - Country:US
Mailing Address - Phone:703-820-4646
Mailing Address - Fax:703-820-7278
Practice Address - Street 1:5881 LEESBURG PIKE
Practice Address - Street 2:SUITE 502
Practice Address - City:BAILEYS CROSSROADS
Practice Address - State:VA
Practice Address - Zip Code:22041-2312
Practice Address - Country:US
Practice Address - Phone:703-820-4646
Practice Address - Fax:703-820-7278
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401006194122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist