=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215687538
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LE-VIET DENTAL AND SURGICAL ARTS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2022
-----------------------------------------------------
Last Update Date | 05/12/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7365 CARNELIAN ST STE 111
-----------------------------------------------------
City | RANCHO CUCAMONGA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91730-1156
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-989-5959
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7365 CARNELIAN ST STE 111
-----------------------------------------------------
City | RANCHO CUCAMONGA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91730-1156
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-989-5959
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER DENTIST / CEO
-----------------------------------------------------
Name | DR. NICK LE
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 415-343-5485
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------