Provider Demographics
NPI:1033778212
Name:NGUYENDAC, DON LE
Entity Type:Individual
Prefix:
First Name:DON
Middle Name:LE
Last Name:NGUYENDAC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4071 LEE RD STE 260
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-2173
Mailing Address - Country:US
Mailing Address - Phone:216-727-0234
Mailing Address - Fax:440-381-8800
Practice Address - Street 1:BLDG. 4250 CLEAR CREEK ROAD
Practice Address - Street 2:SUITE 213
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-285-2014
Practice Address - Fax:254-285-2182
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRES.004093122300000X
TX36128122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist