Provider Demographics
NPI:1295790236
Name:LE, TAM THI NGOC (DMD)
Entity type:Individual
Prefix:MRS
First Name:TAM
Middle Name:THI NGOC
Last Name:LE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MRS
Other - First Name:TAM
Other - Middle Name:THI NGOC
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2051 W WARNER RD
Mailing Address - Street 2:STE. #23
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-2100
Mailing Address - Country:US
Mailing Address - Phone:480-917-0181
Mailing Address - Fax:480-917-2806
Practice Address - Street 1:2051 W WARNER RD
Practice Address - Street 2:STE. #23
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-2100
Practice Address - Country:US
Practice Address - Phone:480-917-0181
Practice Address - Fax:480-917-2806
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ57671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1770602OtherUNITED CONCORDIA
AZ877475OtherAHCCCS
AZAZ0412220OtherBCBS