Provider Demographics
NPI:1649766452
Name:LE, KEELEY NGA (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEELEY
Middle Name:NGA
Last Name:LE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11650 W HACKBARTH DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGTOWN
Mailing Address - State:AZ
Mailing Address - Zip Code:85363-1749
Mailing Address - Country:US
Mailing Address - Phone:714-331-9101
Mailing Address - Fax:
Practice Address - Street 1:17081 W GREENWAY RD STE 120
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85388-9612
Practice Address - Country:US
Practice Address - Phone:623-546-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-04
Last Update Date:2018-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD010039122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist