Provider Demographics
NPI:1720762859
Name:LE, NGUYEN (DMD)
Entity Type:Individual
Prefix:
First Name:NGUYEN
Middle Name:
Last Name:LE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 660682
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0682
Mailing Address - Country:US
Mailing Address - Phone:972-444-8888
Mailing Address - Fax:972-243-6059
Practice Address - Street 1:419 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-5728
Practice Address - Country:US
Practice Address - Phone:972-854-0001
Practice Address - Fax:972-854-0001
Is Sole Proprietor?:No
Enumeration Date:2023-06-09
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX395001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program