Healthcare Provider Details

I. General information

NPI: 1336750470
Provider Name (Legal Business Name): LYNN MY LE D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2020
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 CENTER DR
GAINESVILLE FL
32610-0001
US

IV. Provider business mailing address

11922 69TH WAY
LARGO FL
33773-3503
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-7643
  • Fax:
Mailing address:
  • Phone: 727-251-4906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberDN25141
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: