MEDICARE: DR. RYAN LE D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	8430	NC

General Provider Information

NPI Number	:	1376749697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN LE D.D.S.

Provider Business Mailing Address
First Line	:	8511 CANTILEVER WAY STE 101
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27613-6996
Country	:	US
Telephone Number	:	919-278-7576
Fax Number	:	919-278-7694

Provider Business Practice Location Address
First Line	:	9836 LITTLE RD
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34654-3470
Country	:	US
Telephone Number	:	919-278-7576
Fax Number	:	919-278-7694

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2007
Last Update Date	:	12/22/2022

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