Provider Demographics
NPI:1578655015
Name:LE, NGA T (DDS)
Entity Type:Individual
Prefix:DR
First Name:NGA
Middle Name:T
Last Name:LE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ANGIE
Other - Middle Name:T
Other - Last Name:LE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3001 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-4814
Mailing Address - Country:US
Mailing Address - Phone:316-685-9791
Mailing Address - Fax:316-685-6319
Practice Address - Street 1:3001 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-4814
Practice Address - Country:US
Practice Address - Phone:316-685-9791
Practice Address - Fax:316-685-6319
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS604151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS116978OtherBLUE CROSS BLUE SHIELD