Healthcare Provider Details

I. General information

NPI: 1225132483
Provider Name (Legal Business Name): CHUCK TRUC LE DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 05/14/2021
Certification Date: 05/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2265 W LINCOLN AVE
ANAHEIM CA
92801-6503
US

IV. Provider business mailing address

2265 W LINCOLN AVE
ANAHEIM CA
92801-6503
US

V. Phone/Fax

Practice location:
  • Phone: 714-491-8600
  • Fax: 714-491-8666
Mailing address:
  • Phone: 714-491-8600
  • Fax: 714-491-8666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number37342
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number44850
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number41940
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number49591
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number34587
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number19083
License Number StateCA

VIII. Authorized Official

Name: CHUCK T LE
Title or Position: PRESIDENT
Credential: DDS
Phone: 714-491-8600