Provider Demographics
NPI:1104360718
Name:LEDENTAL LLC
Entity Type:Organization
Organization Name:LEDENTAL LLC
Other - Org Name:CHINOOK FALLS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIN
Authorized Official - Middle Name:MINH
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-544-4889
Mailing Address - Street 1:36840 INDUSTRIAL WAY
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:OR
Mailing Address - Zip Code:97055-9254
Mailing Address - Country:US
Mailing Address - Phone:503-668-8301
Mailing Address - Fax:
Practice Address - Street 1:36840 INDUSTRIAL WAY
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:OR
Practice Address - Zip Code:97055-9254
Practice Address - Country:US
Practice Address - Phone:503-668-8301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-16
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD98411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty