Provider Demographics
NPI:1942218649
Name:LE, PHU HOANG (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHU
Middle Name:HOANG
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 1:4145 BEDFORD RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-5251
Mailing Address - Country:US
Mailing Address - Phone:817-354-7840
Mailing Address - Fax:817-354-8599
Practice Address - Street 1:4145 BEDFORD RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-5251
Practice Address - Country:US
Practice Address - Phone:817-354-7840
Practice Address - Fax:817-354-8599
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX176561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice