Healthcare Provider Details

I. General information

NPI: 1386375228
Provider Name (Legal Business Name): DEVON LE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2022
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 MOUNT HERMON RD STE H
SCOTTS VALLEY CA
95066-4038
US

IV. Provider business mailing address

221 MOUNT HERMON RD STE H
SCOTTS VALLEY CA
95066-4038
US

V. Phone/Fax

Practice location:
  • Phone: 831-440-1830
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number38976
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number109421
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: