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General NPI Number Information
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NPI Number | 1063151991
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Entity Type | Individual
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Provider Name | BAO-TRAN LE DMD
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Gender | Female
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Dates
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Enumeration Date | 05/31/2022
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Last Update Date | 10/16/2022
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Provider Practice Location Address
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Address Line | 21 LOUDOUN ST SE
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City | LEESBURG
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State | VA
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Zip | 20175-3012
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Country | US
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Telephone | 703-782-5171
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Fax |
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Provider Business Mailing Address
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Address Line | 43161 QUILTING LN
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City | SOUTH RIDING
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State | VA
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Zip | 20152-3427
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Country | US
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Telephone | 571-435-1019
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401417982
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License Number State | VA
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