Provider Demographics
NPI:1063522696
Name:LE, DAO THI ANH (DDS)
Entity type:Individual
Prefix:
First Name:DAO
Middle Name:THI ANH
Last Name:LE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:DAO
Other - Middle Name:THI ANH
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2114 SENTER ROAD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-2608
Mailing Address - Country:US
Mailing Address - Phone:408-993-8624
Mailing Address - Fax:408-298-4841
Practice Address - Street 1:2114 SENTER ROAD
Practice Address - Street 2:SUITE 3
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-2608
Practice Address - Country:US
Practice Address - Phone:408-993-8624
Practice Address - Fax:408-298-4841
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32931122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB32931 01OtherMEDICAL
AL 2842929OtherDEA
CAAL2842929OtherDEA