MEDICARE: PHUONG B 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	DN013369	GA

General Provider Information

NPI Number	:	1851415319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHUONG B LE DMD

Provider Business Mailing Address
First Line	:	2993 ARBOR CHASE
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-1800
Country	:	US
Telephone Number	:	770-908-8711
Fax Number	:

Provider Business Practice Location Address
First Line	:	3985 STEVE REYNOLDS BLVD
Second Line	:	BUILDING O, SUITE 101
City	:	NORCROSS
State	:	GA
Zip	:	30093-3035
Country	:	US
Telephone Number	:	678-205-1308
Fax Number	:	678-205-1345

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

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	12/17/2007

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Directions to “ PHUONG B LE DMD” Practice Location

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