Provider Demographics
NPI:1134527781
Name:LEE, DANIEL JAY (DMD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JAY
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 1:5500 HOLMES RUN PKWY STE C3
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-2860
Mailing Address - Country:US
Mailing Address - Phone:703-401-9766
Mailing Address - Fax:
Practice Address - Street 1:5500 HOLMES RUN PKWY STE C3
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-2860
Practice Address - Country:US
Practice Address - Phone:703-401-9766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD157621223G0001X
VA04014147081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice