Provider Demographics
NPI:1578697199
Name:LE, ISAAC H (DDS PA)
Entity Type:Individual
Prefix:
First Name:ISAAC
Middle Name:H
Last Name:LE
Suffix:
Gender:M
Credentials:DDS PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8004 DENTON HWY
Mailing Address - Street 2:STE 136
Mailing Address - City:WATAUGA
Mailing Address - State:TX
Mailing Address - Zip Code:76248
Mailing Address - Country:US
Mailing Address - Phone:817-577-7100
Mailing Address - Fax:817-427-4330
Practice Address - Street 1:8004 DENTON HWY
Practice Address - Street 2:STE 136
Practice Address - City:WATAUGA
Practice Address - State:TX
Practice Address - Zip Code:76248
Practice Address - Country:US
Practice Address - Phone:817-577-7100
Practice Address - Fax:817-427-4330
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20706122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist