Provider Demographics
NPI:1457737561
Name:RICHARD LEE PC
Entity Type:Organization
Organization Name:RICHARD LEE PC
Other - Org Name:PATUXENT ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS, MPH, CAGS
Authorized Official - Phone:240-316-4004
Mailing Address - Street 1:19465 DEERFIELD AVE
Mailing Address - Street 2:STE. 304
Mailing Address - City:LANSDOWNE
Mailing Address - State:VA
Mailing Address - Zip Code:20176-1701
Mailing Address - Country:US
Mailing Address - Phone:703-858-0303
Mailing Address - Fax:703-858-0304
Practice Address - Street 1:23278 THREE NOTCH RD
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:MD
Practice Address - Zip Code:20619-6018
Practice Address - Country:US
Practice Address - Phone:240-316-4004
Practice Address - Fax:240-316-4005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD131981223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty