MEDICARE: DR. BAO-QUYEN THI LE DMD

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	0401412048	VA
2	1223G0001X	General Practice Dentistry	DEN1000752	DC

General Provider Information

NPI Number	:	1689834723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BAO-QUYEN THI LE DMD

Provider Business Mailing Address
First Line	:	10713 ALMOND ST
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22032-3402
Country	:	US
Telephone Number	:	703-232-6672
Fax Number	:	703-691-0740

Provider Business Practice Location Address
First Line	:	1531 MARYLAND AVE NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20002-7604
Country	:	US
Telephone Number	:	202-470-1126
Fax Number	:	202-399-0130

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

Provider Enumeration Date	:	06/12/2008
Last Update Date	:	11/10/2008

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