Healthcare Provider Details

I. General information

NPI: 1255779609
Provider Name (Legal Business Name): NHU LE DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2013
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4039 13TH ST
SAINT CLOUD FL
34769-6772
US

IV. Provider business mailing address

3518 JAMAICA RUN LN APT 1713
KISSIMMEE FL
34741-2562
US

V. Phone/Fax

Practice location:
  • Phone: 407-892-1643
  • Fax:
Mailing address:
  • Phone: 985-303-2920
  • 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 StateNY
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN 20542
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: