Provider Demographics
NPI:1275621401
Name:DO, NGA LE (DDS)
Entity Type:Individual
Prefix:
First Name:NGA
Middle Name:LE
Last Name:DO
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 1:412 8TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-3984
Mailing Address - Country:US
Mailing Address - Phone:510-763-6811
Mailing Address - Fax:
Practice Address - Street 1:412 8TH ST STE C
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-3984
Practice Address - Country:US
Practice Address - Phone:510-763-6811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA366521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice