Provider Demographics
NPI:1780992909
Name:COLLIN M. LE, D.D.S, P.L.L.C.
Entity type:Organization
Organization Name:COLLIN M. LE, D.D.S, P.L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COLLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:910-796-8305
Mailing Address - Street 1:6419 CAROLINA BEACH RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-2909
Mailing Address - Country:US
Mailing Address - Phone:910-796-8305
Mailing Address - Fax:910-796-8339
Practice Address - Street 1:6419 CAROLINA BEACH RD
Practice Address - Street 2:SUITE E
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-2909
Practice Address - Country:US
Practice Address - Phone:910-796-8305
Practice Address - Fax:910-796-8339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC87701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty