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General NPI Number Information
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NPI Number | 1760117303
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Entity Type | Organization
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Legal Business Name | DMDLE,
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Dates
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Enumeration Date | 07/18/2022
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Last Update Date | 07/18/2022
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Provider Practice Location Address
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Address Line | 5901 OLD FREDERICKSBURG RD STE D102
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City | AUSTIN
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State | TX
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Zip | 78749-1210
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Country | US
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Telephone | 512-892-9900
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Fax |
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Provider Business Mailing Address
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Address Line | 5901 OLD FREDERICKSBURG RD STE D102
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City | AUSTIN
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State | TX
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Zip | 78749-1210
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Country | US
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Telephone | 951-231-7246
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL LE
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Credential | DMD
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Telephone | 951-231-7246
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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 |
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License Number State |
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