Provider Demographics
NPI:1467788646
Name:LE, ANDY (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDY
Middle Name:
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 1:1556 BOSQUE DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-6427
Mailing Address - Country:US
Mailing Address - Phone:972-898-3694
Mailing Address - Fax:
Practice Address - Street 1:612 NW 25TH ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76164-7009
Practice Address - Country:US
Practice Address - Phone:972-898-3694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-23
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24549122300000X
CA105196122300000X
ORD10741122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist