=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700241486
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THIEN V LE DDS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2015
-----------------------------------------------------
Last Update Date | 01/06/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5105C BACKLICK RD
-----------------------------------------------------
City | ANNANDALE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22003-6042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-942-6612
-----------------------------------------------------
Fax | 703-942-6683
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6815 HOPEWELL AVE
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22151-3841
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-942-6612
-----------------------------------------------------
Fax | 703-942-6683
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | THIEN V LE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 706-942-6612
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 0401412206
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------