Individual
SOMANG LEE-THACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
4707 COLUMBIA PIKE UNIT C1, ARLINGTON, VA 22204-5923
(703) 705-4022
Mailing address
4101 FOUNTAINSIDE LN, FAIRFAX, VA 22030-6094
(502) 802-1147
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0401418880
VA
Other
Enumeration date
06/04/2024
Last updated
04/18/2025
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