Provider Demographics
NPI:1104558766
Name:LE, DAT DAVID (DDS)
Entity type:Individual
Prefix:
First Name:DAT
Middle Name:DAVID
Last Name:LE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 N URSULA ST APT 214
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-7604
Mailing Address - Country:US
Mailing Address - Phone:954-614-0768
Mailing Address - Fax:
Practice Address - Street 1:8383 PECOS ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80221-3957
Practice Address - Country:US
Practice Address - Phone:954-614-0768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00205184122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist