Provider Demographics
NPI:1689834723
Name:LE, BAO-QUYEN THI (DMD)
Entity Type:Individual
Prefix:DR
First Name:BAO-QUYEN
Middle Name:THI
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 1:10713 ALMOND ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22032-3402
Mailing Address - Country:US
Mailing Address - Phone:703-232-6672
Mailing Address - Fax:703-691-0740
Practice Address - Street 1:1531 MARYLAND AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-7604
Practice Address - Country:US
Practice Address - Phone:202-470-1126
Practice Address - Fax:202-399-0130
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014120481223G0001X
DCDEN10007521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice