Provider Demographics
NPI:1629136957
Name:LE, DANIEL LOC (DDS, MS, PA)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:LOC
Last Name:LE
Suffix:
Gender:M
Credentials:DDS, MS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15914 FLOWERCROFT CT
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-4960
Mailing Address - Country:US
Mailing Address - Phone:832-858-4615
Mailing Address - Fax:
Practice Address - Street 1:14315 CYPRESS ROSEHILL RD.
Practice Address - Street 2:SUITE 100
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429
Practice Address - Country:US
Practice Address - Phone:713-772-3499
Practice Address - Fax:717-772-3959
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX198551223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX202398563OtherTAX IDENTIFICATION NUMBER
TX1718215-01Medicaid