Provider Demographics
NPI:1891205993
Name:LEE, CAROLINE YOUNG (DMD)
Entity Type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:YOUNG
Last Name:LEE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4452 RALEIGH AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-6744
Mailing Address - Country:US
Mailing Address - Phone:281-881-5927
Mailing Address - Fax:
Practice Address - Street 1:4452 RALEIGH AVE APT 201
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-6744
Practice Address - Country:US
Practice Address - Phone:281-881-5927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014157461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice