Provider Demographics
NPI:1457512287
Name:PHU H. LE, D.D.S., P.A.
Entity Type:Organization
Organization Name:PHU H. LE, D.D.S., P.A.
Other - Org Name:ADVANCED FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHU
Authorized Official - Middle Name:H
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-337-0072
Mailing Address - Street 1:1540 KELLER PKWY
Mailing Address - Street 2:SUITE 140
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-3686
Mailing Address - Country:US
Mailing Address - Phone:817-337-0072
Mailing Address - Fax:817-337-0073
Practice Address - Street 1:1540 KELLER PKWY
Practice Address - Street 2:SUITE 140
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-3686
Practice Address - Country:US
Practice Address - Phone:817-337-0072
Practice Address - Fax:817-337-0073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17656122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX009339502Medicaid