Provider Demographics
NPI:1346098720
Name:LEE, HYESOO (DDS)
Entity type:Individual
Prefix:
First Name:HYESOO
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1899 ORACLE WAY APT 1422
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-4872
Mailing Address - Country:US
Mailing Address - Phone:410-208-8653
Mailing Address - Fax:
Practice Address - Street 1:11211 WAPLES MILL RD STE 210
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7406
Practice Address - Country:US
Practice Address - Phone:703-293-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-09
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401418805122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist