Provider Demographics
NPI:1457459406
Name:LE, KENNETH T (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:T
Last Name:LE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 BRANDERMILL DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-6600
Mailing Address - Country:US
Mailing Address - Phone:714-269-2088
Mailing Address - Fax:
Practice Address - Street 1:6020 BADURA AVE STE 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-4716
Practice Address - Country:US
Practice Address - Phone:702-880-4266
Practice Address - Fax:702-792-4266
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43457122300000X
NV4586T122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist