Provider Demographics
NPI:1154904837
Name:FONTES LEE PLLC
Entity type:Organization
Organization Name:FONTES LEE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ATTN: FERNANDA
Authorized Official - Middle Name:G
Authorized Official - Last Name:FONTES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-645-5820
Mailing Address - Street 1:4229 LAFAYETTE CENTER DR STE 1400
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-1267
Mailing Address - Country:US
Mailing Address - Phone:734-645-5820
Mailing Address - Fax:
Practice Address - Street 1:4229 LAFAYETTE CENTER DR STE 1400
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-1267
Practice Address - Country:US
Practice Address - Phone:703-378-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty