Provider Demographics
NPI:1083275820
Name:LE, RYAN (DMD, MBA, MMB)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:LE
Suffix:
Gender:M
Credentials:DMD, MBA, MMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6331 ADRIANA AVE APT 1408
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-4002
Mailing Address - Country:US
Mailing Address - Phone:980-721-6170
Mailing Address - Fax:
Practice Address - Street 1:1325 N GOLDENROD RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-8332
Practice Address - Country:US
Practice Address - Phone:407-381-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2024-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN286261223G0001X
NC113661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice