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General NPI Number Information
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NPI Number | 1891068268
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Entity Type | Organization
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Legal Business Name | PHU T. LE, DDS, PC
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Dates
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Enumeration Date | 02/16/2012
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Last Update Date | 02/16/2012
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Provider Practice Location Address
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Address Line | 8227 OLD COURTHOUSE RD SUITE 210
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City | VIENNA
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State | VA
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Zip | 22182-3815
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Country | US
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Telephone | 703-288-4862
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Fax | 703-288-4863
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Provider Business Mailing Address
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Address Line | 8227 OLD COURTHOUSE RD SUITE 210
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City | VIENNA
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State | VA
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Zip | 22182-3815
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Country | US
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Telephone | 703-288-4862
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Fax | 703-288-4863
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PHU LE
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Credential | DDS
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Telephone | 202-257-0113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 0401411700
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License Number State | VA
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