Healthcare Provider Details

I. General information

NPI: 1093164097
Provider Name (Legal Business Name): MICHAEL T LE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16560 R R 620 STE 104
ROUND ROCK TX
78681-5803
US

IV. Provider business mailing address

4048 BERKMAN DR
AUSTIN TX
78723-4543
US

V. Phone/Fax

Practice location:
  • Phone: 512-432-5450
  • Fax:
Mailing address:
  • Phone: 951-231-7246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number6847
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number32636
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: