Provider Demographics
NPI:1518267525
Name:LE, KHANH XUAN (DMD)
Entity Type:Individual
Prefix:
First Name:KHANH
Middle Name:XUAN
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 1:14 SPRING GLEN CIR
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-8328
Mailing Address - Country:US
Mailing Address - Phone:857-389-3710
Mailing Address - Fax:
Practice Address - Street 1:66 MAYOR THOMAS J MCGRATH HWY
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-5347
Practice Address - Country:US
Practice Address - Phone:617-472-1036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18555211223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics