MEDICARE: HI-TECH DENTAL OFFICE, VINCENT H. LE D.D.S. INC.

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

General Provider Information

NPI Number	:	1477218063
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HI-TECH DENTAL OFFICE, VINCENT H. LE D.D.S. INC.

Provider Business Mailing Address
First Line	:	5507 EL CAJON BLVD STE A
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-3624
Country	:	US
Telephone Number	:	619-582-5364
Fax Number	:

Provider Business Practice Location Address
First Line	:	5507 EL CAJON BLVD STE A
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-3624
Country	:	US
Telephone Number	:	619-582-5364
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	VINCENT LE
Credential	:	DDS
Telephone Number	:	619-582-5364

Provider Enumeration Date	:	11/08/2021
Last Update Date	:	11/08/2021

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