Provider Demographics
NPI:1093198533
Name:LE, PHUONG MINH (DMD)
Entity Type:Individual
Prefix:
First Name:PHUONG
Middle Name:MINH
Last Name:LE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 RAMROD AVE
Mailing Address - Street 2:APT 2628
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-2378
Mailing Address - Country:US
Mailing Address - Phone:408-518-1275
Mailing Address - Fax:
Practice Address - Street 1:2001 RAMROD AVE
Practice Address - Street 2:APT 2628
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-2378
Practice Address - Country:US
Practice Address - Phone:408-518-1275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6679122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist