Provider Demographics
NPI:1679632533
Name:LE, MAI-TRINH THI (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAI-TRINH
Middle Name:THI
Last Name:LE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3608 ROBINWOOD TER
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-4328
Mailing Address - Country:US
Mailing Address - Phone:952-935-5404
Mailing Address - Fax:
Practice Address - Street 1:4959 EXCELSIOR BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-3033
Practice Address - Country:US
Practice Address - Phone:952-920-8774
Practice Address - Fax:952-920-8979
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND115811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice