MEDICARE: THANH HA LE, DDS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	7057	AZ

General Provider Information

NPI Number	:	1427479302
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THANH HA LE, DDS PLLC

Provider Business Mailing Address
First Line	:	2320 E BASELINE RD STE 160
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85042-6951
Country	:	US
Telephone Number	:	602-243-6900
Fax Number	:	602-243-6902

Provider Business Practice Location Address
First Line	:	2320 E BASELINE RD STE 160
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85042-6951
Country	:	US
Telephone Number	:	602-243-6900
Fax Number	:	602-243-6902

Authorized Official
Title or Position	:	OWNER
Name	:	DR. THANH HA THI LE
Credential	:	DDS
Telephone Number	:	602-243-6900

Provider Enumeration Date	:	12/19/2013
Last Update Date	:	12/19/2013

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