Provider Demographics
NPI:1245738947
Name:NANCY H. LE, DDS, MS, INC.
Entity Type:Organization
Organization Name:NANCY H. LE, DDS, MS, INC.
Other - Org Name:FAIRFIELD ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:HUYNH
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:707-428-3200
Mailing Address - Street 1:1411 OLIVER RD STE 330
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-3425
Mailing Address - Country:US
Mailing Address - Phone:707-428-3200
Mailing Address - Fax:707-428-6045
Practice Address - Street 1:1411 OLIVER RD STE 330
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-3425
Practice Address - Country:US
Practice Address - Phone:707-428-3200
Practice Address - Fax:707-428-6045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-28
Last Update Date:2018-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA633431223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty