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NPI Code Detail

MEDICARE: JENNIFER LE DDS

MEDICARE: JENNIFER 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
11223G0001XGeneral Practice Dentistry37517TX

General Provider Information

NPI Number : 1710550868
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER LE DDS
Provider Business Mailing Address
First Line : 628 LAURA LN
Second Line :
City : GRAND PRAIRIE
State : TX
Zip : 75052-2811
Country : US
Telephone Number : 469-261-9015
Fax Number :
Provider Business Practice Location Address
First Line : 2815 AZLE AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76106-5106
Country : US
Telephone Number : 817-624-0222
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/16/2021
Last Update Date : 07/16/2021

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