Provider Demographics
NPI:1659473965
Name:LE, ANDY V (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDY
Middle Name:V
Last Name:LE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 9TH ST
Mailing Address - Street 2:SUITE 503
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-6514
Mailing Address - Country:US
Mailing Address - Phone:510-839-5889
Mailing Address - Fax:510-836-3016
Practice Address - Street 1:373 9TH ST
Practice Address - Street 2:SUITE 503
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-6514
Practice Address - Country:US
Practice Address - Phone:510-839-5889
Practice Address - Fax:510-836-3016
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51610122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA51610OtherCALIFORNIA DENTAL BOARD