Provider Demographics
NPI:1659493997
Name:HALE, LETTI L (DDS)
Entity Type:Individual
Prefix:DR
First Name:LETTI
Middle Name:L
Last Name:HALE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2213 N GREEN VALLEY PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-5076
Mailing Address - Country:US
Mailing Address - Phone:702-547-6453
Mailing Address - Fax:702-547-6452
Practice Address - Street 1:2213 N GREEN VALLEY PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-5076
Practice Address - Country:US
Practice Address - Phone:702-547-6453
Practice Address - Fax:702-547-6452
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4676T1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100505914Medicaid