Provider Demographics
NPI:1912162470
Name:JOHN M. LE DDS, LLC
Entity Type:Organization
Organization Name:JOHN M. LE DDS, LLC
Other - Org Name:FRIENDLY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MINH
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:913-888-9399
Mailing Address - Street 1:10616 W 87TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66214-1651
Mailing Address - Country:US
Mailing Address - Phone:913-888-9399
Mailing Address - Fax:913-888-9491
Practice Address - Street 1:10616 W 87TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66214-1651
Practice Address - Country:US
Practice Address - Phone:913-888-9399
Practice Address - Fax:913-888-9491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS70651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO408708600Medicaid
KS100328490BMedicaid