=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952066151
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TUANH LE, DDS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2021
-----------------------------------------------------
Last Update Date | 11/02/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4355 NICOLS RD
-----------------------------------------------------
City | EAGAN
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55122-1912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-431-5088
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6308 CONCORD AVE
-----------------------------------------------------
City | EDINA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55424-1738
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-370-8034
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | TUANH LE
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 763-370-8034
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------