=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326446691
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHINH N. LE. D.D.S. L.L.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/18/2014
-----------------------------------------------------
Last Update Date | 12/18/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18220 CONTOUR RD
-----------------------------------------------------
City | MONTGOMERY VILLAGE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20877-2623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-208-0002
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18220 CONTOUR RD
-----------------------------------------------------
City | MONTGOMERY VILLAGE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20877-2623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-208-0002
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ DENTIST
-----------------------------------------------------
Name | DR. CHINH NGUYEN LE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 301-208-0002
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 13448
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------