Provider Demographics
NPI:1922196211
Name:LE, QUAN VAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:QUAN
Middle Name:VAN
Last Name:LE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2070 CHAIN BRIDGE RD
Mailing Address - Street 2:SUITE 530
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2536
Mailing Address - Country:US
Mailing Address - Phone:703-448-3527
Mailing Address - Fax:703-448-3773
Practice Address - Street 1:2070 CHAIN BRIDGE RD
Practice Address - Street 2:SUITE 530
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-2536
Practice Address - Country:US
Practice Address - Phone:703-448-3527
Practice Address - Fax:703-448-3773
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401007797122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist