Provider Demographics
NPI:1982814133
Name:BENJAMIN K. LEE DMD & ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:BENJAMIN K. LEE DMD & ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:703-830-9990
Mailing Address - Street 1:13880 BRADDOCK RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-2459
Mailing Address - Country:US
Mailing Address - Phone:703-830-9990
Mailing Address - Fax:703-830-5400
Practice Address - Street 1:13880 BRADDOCK RD
Practice Address - Street 2:SUITE 109
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2459
Practice Address - Country:US
Practice Address - Phone:703-830-9990
Practice Address - Fax:703-830-5400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401007961261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental