MEDICARE: LE DENTAL INC.

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1982469813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LE DENTAL INC.

Provider Business Mailing Address
First Line	:	873 COYOTE ST
Second Line	:
City	:	MILPITAS
State	:	CA
Zip	:	95035-3840
Country	:	US
Telephone Number	:	510-565-4054
Fax Number	:

Provider Business Practice Location Address
First Line	:	2048 STORY RD
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95122-1668
Country	:	US
Telephone Number	:	510-565-4054
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SUONG LE
Credential	:	DDS
Telephone Number	:	510-565-4054

Provider Enumeration Date	:	02/20/2024
Last Update Date	:	03/04/2024

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Directions to “LE DENTAL INC. ” Practice Location

Language	Start Address	Practice Location

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