Provider Demographics
NPI:1649467440
Name:LEE, DAN WON (DDS)
Entity type:Individual
Prefix:DR
First Name:DAN
Middle Name:WON
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:SANG
Other - Middle Name:WON
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:10533 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-4206
Mailing Address - Country:US
Mailing Address - Phone:571-455-0909
Mailing Address - Fax:
Practice Address - Street 1:8170 SILVERBROOK RD STE D
Practice Address - Street 2:
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-2956
Practice Address - Country:US
Practice Address - Phone:703-495-9992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014118681223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics