Provider Demographics
NPI:1295872893
Name:LE, VAN ANH MONG (DDS)
Entity type:Individual
Prefix:DR
First Name:VAN ANH
Middle Name:MONG
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 1:9633 N SUNSET LN
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-5334
Mailing Address - Country:US
Mailing Address - Phone:414-902-2366
Mailing Address - Fax:414-385-6612
Practice Address - Street 1:1555 S LAYTON BLVD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-1924
Practice Address - Country:US
Practice Address - Phone:414-902-2366
Practice Address - Fax:414-385-6612
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4109122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist