Provider Demographics
NPI:1588021398
Name:SUONG LE DENTAL CORPORATION
Entity Type:Organization
Organization Name:SUONG LE DENTAL CORPORATION
Other - Org Name:CHILDRENS DENTAL PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUONG
Authorized Official - Middle Name:T
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-375-0523
Mailing Address - Street 1:805 FLETCHER LN
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-1010
Mailing Address - Country:US
Mailing Address - Phone:510-592-7888
Mailing Address - Fax:
Practice Address - Street 1:805 FLETCHER LN
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-1010
Practice Address - Country:US
Practice Address - Phone:510-592-7888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-25
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52747122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty