Provider Demographics
NPI:1083464986
Name:DR. VIVIAN LE DDS, INC
Entity Type:Organization
Organization Name:DR. VIVIAN LE DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-475-4479
Mailing Address - Street 1:321 INGER DR UNIT M120
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-8606
Mailing Address - Country:US
Mailing Address - Phone:303-475-4479
Mailing Address - Fax:
Practice Address - Street 1:1774 S BROADWAY
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-7604
Practice Address - Country:US
Practice Address - Phone:303-475-4479
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty