Provider Demographics
NPI:1245518471
Name:LE, CHRISTINE P (DDS)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:P
Last Name:LE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2815 AZLE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76106-5106
Mailing Address - Country:US
Mailing Address - Phone:817-624-0222
Mailing Address - Fax:817-624-0221
Practice Address - Street 1:2815 AZLE AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76106-5106
Practice Address - Country:US
Practice Address - Phone:817-624-0222
Practice Address - Fax:817-624-0221
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX265291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice