Provider Demographics
NPI:1629540513
Name:LE & LE DENTAL CORPORATION
Entity Type:Organization
Organization Name:LE & LE DENTAL CORPORATION
Other - Org Name:SAN MARCOS SMILE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VINH
Authorized Official - Middle Name:BAO
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-591-9494
Mailing Address - Street 1:3643 GRAND AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-2336
Mailing Address - Country:US
Mailing Address - Phone:760-536-3648
Mailing Address - Fax:760-734-5762
Practice Address - Street 1:3643 GRAND AVE STE A
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-2336
Practice Address - Country:US
Practice Address - Phone:760-536-3648
Practice Address - Fax:760-734-5762
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LE & LE DENTAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-18
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty