Provider Demographics
NPI:1821112285
Name:LE, BILL BAOQUANG (DMD)
Entity Type:Individual
Prefix:DR
First Name:BILL
Middle Name:BAOQUANG
Last Name:LE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:MR
Other - First Name:BAO
Other - Middle Name:QUANG
Other - Last Name:LE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10102 VALLEY VIEW ST
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-4344
Mailing Address - Country:US
Mailing Address - Phone:714-229-4898
Mailing Address - Fax:714-229-4899
Practice Address - Street 1:10102 VALLEY VIEW ST
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-4344
Practice Address - Country:US
Practice Address - Phone:714-229-4898
Practice Address - Fax:714-229-4899
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA369571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice