Healthcare Provider Details

I. General information

NPI: 1649115619
Provider Name (Legal Business Name): MATTHEW LE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 N HERCULES AVE
CLEARWATER FL
33765-2024
US

IV. Provider business mailing address

831 N HERCULES AVE
CLEARWATER FL
33765-2024
US

V. Phone/Fax

Practice location:
  • Phone: 702-202-5733
  • Fax:
Mailing address:
  • Phone: 702-202-5733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number31637
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: