Provider Demographics
NPI:1104056787
Name:LE, THANH-TRUC NGOC (DDS)
Entity type:Individual
Prefix:
First Name:THANH-TRUC
Middle Name:NGOC
Last Name:LE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2522 BRIARBROOK LN
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-3900
Mailing Address - Country:US
Mailing Address - Phone:469-789-4756
Mailing Address - Fax:
Practice Address - Street 1:2522 BRIARBROOK LN
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-3900
Practice Address - Country:US
Practice Address - Phone:469-789-4756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-17
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24658122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist