Healthcare Provider Details

I. General information

NPI: 1629540513
Provider Name (Legal Business Name): LE & LE DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2018
Last Update Date: 06/22/2024
Certification Date: 06/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3643 GRAND AVE STE A
SAN MARCOS CA
92078-2336
US

IV. Provider business mailing address

3643 GRAND AVE STE A
SAN MARCOS CA
92078-2336
US

V. Phone/Fax

Practice location:
  • Phone: 760-536-3648
  • Fax: 760-734-5762
Mailing address:
  • Phone: 760-536-3648
  • Fax: 760-734-5762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VINH BAO LE
Title or Position: VICE PRESIDENT
Credential: DDS
Phone: 760-591-9494