Provider Demographics
NPI:1285641662
Name:LE, JENNIFER (DMD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:LE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 WAKEFIELD PINES DR
Mailing Address - Street 2:SUITE 115
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-7078
Mailing Address - Country:US
Mailing Address - Phone:919-488-0111
Mailing Address - Fax:919-488-0104
Practice Address - Street 1:2810 WAKEFIELD PINES DR
Practice Address - Street 2:SUITE 115
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-7078
Practice Address - Country:US
Practice Address - Phone:919-488-0111
Practice Address - Fax:919-488-0104
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC73751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice