Provider Demographics
NPI:1225774300
Name:LE, MARY ANNA ARLENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY ANNA
Middle Name:ARLENE
Last Name:LE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MARY ANNA
Other - Middle Name:ARLENE
Other - Last Name:ELLIOTT ONTIVEROS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:7500 BRANFORD PL APT 2249
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3737
Mailing Address - Country:US
Mailing Address - Phone:832-488-3517
Mailing Address - Fax:
Practice Address - Street 1:23800 NORTHWEST FWY STE 201
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-5745
Practice Address - Country:US
Practice Address - Phone:832-220-1855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-11
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX385011223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty