Provider Demographics
NPI:1225715584
Name:LE, THI (DDS)
Entity Type:Individual
Prefix:
First Name:THI
Middle Name:
Last Name:LE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4650 FARM TO MARKET 1626 #104
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640
Mailing Address - Country:US
Mailing Address - Phone:512-299-9697
Mailing Address - Fax:
Practice Address - Street 1:4650 FARM TO MARKET 1626
Practice Address - Street 2:#104
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-9998
Practice Address - Country:US
Practice Address - Phone:512-299-9697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX394901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice