Provider Demographics
NPI:1760445902
Name:LEI, RICHARD T (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:T
Last Name:LEI
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 1:5500 FRIENDSHIP BLVD.
Mailing Address - Street 2:#2217
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-7277
Mailing Address - Country:US
Mailing Address - Phone:301-657-3145
Mailing Address - Fax:
Practice Address - Street 1:PENTAGON TRI-SERVICE DENTAL CLINIC
Practice Address - Street 2:5802 ARMY PENTAGON, CORRIDOR 8, RM MF855
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20310-0001
Practice Address - Country:US
Practice Address - Phone:703-692-8700
Practice Address - Fax:703-692-6123
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD108311223G0001X
DCDEN10005081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice