Provider Demographics
NPI:1932350071
Name:LE, YVONNE P (DDS)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:P
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 1:1888 MATTERHORN ST
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-6687
Mailing Address - Country:US
Mailing Address - Phone:209-551-6988
Mailing Address - Fax:
Practice Address - Street 1:2508 OAKDALE RD STE B4
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-9013
Practice Address - Country:US
Practice Address - Phone:209-551-6988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA516091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG98632-01-HFOtherHEALTHY FAMILY, CALIFORNIA
CA001858255OtherUNITED CONCORDIA
CA13999OtherPUD