Provider Demographics
NPI:1568607695
Name:LE, QUOC-ALBERT D (DDS)
Entity Type:Individual
Prefix:
First Name:QUOC-ALBERT
Middle Name:D
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 1:351 HOSPITAL RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3509
Mailing Address - Country:US
Mailing Address - Phone:949-646-7707
Mailing Address - Fax:949-646-7795
Practice Address - Street 1:351 HOSPITAL RD
Practice Address - Street 2:SUITE 201
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3509
Practice Address - Country:US
Practice Address - Phone:949-646-7707
Practice Address - Fax:949-646-7795
Is Sole Proprietor?:No
Enumeration Date:2008-12-03
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX243601223G0001X
CA625251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX197116005Medicaid
TX197116006Medicaid