Provider Demographics
NPI:1801395397
Name:LE DENTAL LLC
Entity Type:Organization
Organization Name:LE DENTAL LLC
Other - Org Name:ICARE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:TUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-456-8118
Mailing Address - Street 1:931 S DECATUR BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-3918
Mailing Address - Country:US
Mailing Address - Phone:702-551-4224
Mailing Address - Fax:702-534-6546
Practice Address - Street 1:931 S DECATUR BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-3918
Practice Address - Country:US
Practice Address - Phone:702-551-4224
Practice Address - Fax:702-534-6546
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LE DENTAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-09
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV37761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100503629Medicaid