Provider Demographics
NPI:1821251141
Name:LEE, RICHARD JOHN (DMD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:JOHN
Last Name:LEE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19465 DEERFIELD AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:VA
Mailing Address - Zip Code:20176-1705
Mailing Address - Country:US
Mailing Address - Phone:703-220-4667
Mailing Address - Fax:
Practice Address - Street 1:44220 AIRPORT VIEW DR
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:MD
Practice Address - Zip Code:20636-3159
Practice Address - Country:US
Practice Address - Phone:240-316-4004
Practice Address - Fax:703-858-0304
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014122801223X0400X
DCDEN 10003961223X0400X
FLDN 167681223X0400X
MD131981223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA025944600Medicaid
MD025944601Medicaid