Provider Demographics
NPI:1346331592
Name:LE, NGOC THANH THI (GENERAL DENTIST)
Entity Type:Individual
Prefix:
First Name:NGOC THANH
Middle Name:THI
Last Name:LE
Suffix:
Gender:F
Credentials:GENERAL DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 CARVER ROAD
Mailing Address - Street 2:STE 5
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4787
Mailing Address - Country:US
Mailing Address - Phone:209-577-6959
Mailing Address - Fax:209-577-1329
Practice Address - Street 1:1100 CARVER ROAD
Practice Address - Street 2:STE 5
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4787
Practice Address - Country:US
Practice Address - Phone:209-577-6959
Practice Address - Fax:209-577-1329
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA408451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice