Provider Demographics
NPI:1649394248
Name:LE, LONG HOANG (DDS)
Entity Type:Individual
Prefix:DR
First Name:LONG
Middle Name:HOANG
Last Name:LE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1219 WHITE SANDS DR
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-5488
Mailing Address - Country:US
Mailing Address - Phone:760-295-1750
Mailing Address - Fax:760-295-1750
Practice Address - Street 1:1595 GRAND AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-2450
Practice Address - Country:US
Practice Address - Phone:760-295-1750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA506321223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics