Healthcare Provider Details

I. General information

NPI: 1205333739
Provider Name (Legal Business Name): QUE NGUYET LE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2018
Last Update Date: 03/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 S MAIN ST STE 212
BLACKSBURG VA
24060-4725
US

IV. Provider business mailing address

945 CANYON RIDGE ROAD #207
BLACKSBURG VA
24060
US

V. Phone/Fax

Practice location:
  • Phone: 540-552-5433
  • Fax:
Mailing address:
  • Phone: 571-234-3271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401416378
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: