Provider Demographics
NPI:1215013370
Name:LE, PETER NK (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:NK
Last Name:LE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-3015
Mailing Address - Country:US
Mailing Address - Phone:925-447-3057
Mailing Address - Fax:925-447-3058
Practice Address - Street 1:1350 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-3015
Practice Address - Country:US
Practice Address - Phone:925-447-3057
Practice Address - Fax:925-447-3058
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA464861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice