Provider Demographics
NPI:1922299445
Name:LE, TIN MINH (DMD)
Entity Type:Individual
Prefix:
First Name:TIN
Middle Name:MINH
Last Name:LE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4130 SE 65TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-3641
Mailing Address - Country:US
Mailing Address - Phone:503-544-4889
Mailing Address - Fax:
Practice Address - Street 1:1739 NE 122ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-1914
Practice Address - Country:US
Practice Address - Phone:503-544-4889
Practice Address - Fax:503-544-4889
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD9841122300000X, 1223S0112X
HIDT23111223G0001X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice