Provider Demographics
NPI:1982665709
Name:MCILVEEN, LEZLEY PATRICIA (BDS,MS)
Entity Type:Individual
Prefix:DR
First Name:LEZLEY
Middle Name:PATRICIA
Last Name:MCILVEEN
Suffix:
Gender:F
Credentials:BDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 ELDEN ST
Mailing Address - Street 2:SUITE #130
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4876
Mailing Address - Country:US
Mailing Address - Phone:703-689-3900
Mailing Address - Fax:703-689-3903
Practice Address - Street 1:131 ELDEN ST
Practice Address - Street 2:SUITE #130
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4876
Practice Address - Country:US
Practice Address - Phone:703-689-3900
Practice Address - Fax:703-689-3903
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010068841223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry