Provider Demographics
NPI:1770242885
Name:MINH-TAM LE,DDS, LLC
Entity Type:Organization
Organization Name:MINH-TAM LE,DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MINH-TAM
Authorized Official - Middle Name:NGUYEN
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:571-274-4578
Mailing Address - Street 1:555 MASSACHUSETTS AVE NW APT 409
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-4719
Mailing Address - Country:US
Mailing Address - Phone:571-274-4578
Mailing Address - Fax:
Practice Address - Street 1:7115 LEESBURG PIKE STE 310
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22043-2301
Practice Address - Country:US
Practice Address - Phone:888-537-3275
Practice Address - Fax:202-449-9797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1235521659Medicaid