Provider Demographics
NPI:1205059094
Name:LE, KHOA TRONG (DDS)
Entity type:Individual
Prefix:DR
First Name:KHOA
Middle Name:TRONG
Last Name:LE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4438 DOWLEN RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706
Mailing Address - Country:US
Mailing Address - Phone:409-898-4252
Mailing Address - Fax:409-898-4253
Practice Address - Street 1:4438 DOWLEN RD
Practice Address - Street 2:SUITE 108
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706
Practice Address - Country:US
Practice Address - Phone:409-898-4252
Practice Address - Fax:409-898-4253
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21351122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist