MEDICARE: COLLIN M. LE, D.D.S, P.L.L.C.

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	8770	NC

General Provider Information

NPI Number	:	1780992909
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLLIN M. LE, D.D.S, P.L.L.C.

Provider Business Mailing Address
First Line	:	6419 CAROLINA BEACH RD
Second Line	:	SUITE E
City	:	WILMINGTON
State	:	NC
Zip	:	28412-2909
Country	:	US
Telephone Number	:	910-796-8305
Fax Number	:	910-796-8339

Provider Business Practice Location Address
First Line	:	6419 CAROLINA BEACH RD
Second Line	:	SUITE E
City	:	WILMINGTON
State	:	NC
Zip	:	28412-2909
Country	:	US
Telephone Number	:	910-796-8305
Fax Number	:	910-796-8339

Authorized Official
Title or Position	:	OWNER
Name	:	DR. COLLIN LE
Credential	:	D.D.S
Telephone Number	:	910-796-8305

Provider Enumeration Date	:	09/22/2010
Last Update Date	:	01/14/2011

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