Provider Demographics
NPI:1033832811
Name:DU, PHUONG LE (DMD)
Entity Type:Individual
Prefix:DR
First Name:PHUONG
Middle Name:LE
Last Name:DU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8215 POWELL DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95212-3436
Mailing Address - Country:US
Mailing Address - Phone:209-351-5203
Mailing Address - Fax:
Practice Address - Street 1:8215 POWELL DR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95212-3436
Practice Address - Country:US
Practice Address - Phone:209-351-5203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108104122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist