MEDICARE: DR. QUANG LE DDS

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	1223G0001X	General Practice Dentistry	D5777	AZ

General Provider Information

NPI Number	:	1386084689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. QUANG LE DDS

Provider Business Mailing Address
First Line	:	690 E WARNER RD STE 126
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85296-3057
Country	:	US
Telephone Number	:	480-882-9588
Fax Number	:	480-813-6100

Provider Business Practice Location Address
First Line	:	690 E WARNER RD STE 126
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85296-3057
Country	:	US
Telephone Number	:	480-882-9588
Fax Number	:	480-813-6100

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

Provider Enumeration Date	:	07/01/2013
Last Update Date	:	07/01/2013

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