Healthcare Provider Details

I. General information

NPI: 1013235704
Provider Name (Legal Business Name): HUONG LE, DMD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2010
Last Update Date: 05/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 N BROADWAY ST SUITE 2
ABERDEEN WA
98520-3947
US

IV. Provider business mailing address

218 N BROADWAY ST SUITE 2
ABERDEEN WA
98520-3947
US

V. Phone/Fax

Practice location:
  • Phone: 360-533-1660
  • Fax: 360-533-2556
Mailing address:
  • Phone: 360-533-1660
  • Fax: 360-533-2556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDE 00009906
License Number StateWA

VIII. Authorized Official

Name: DR. HUONG T LE
Title or Position: ORTHODONTIST
Credential: D.M.D
Phone: 503-734-5859