Provider Demographics
NPI:1285073635
Name:LE, ISAAC TUAN (DDS)
Entity type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:TUAN
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 1:520 S 14TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-4608
Mailing Address - Country:US
Mailing Address - Phone:479-782-3005
Mailing Address - Fax:479-494-7490
Practice Address - Street 1:520 SO. 14TH STREET
Practice Address - Street 2:FORT SMITH DENTISTRY
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901
Practice Address - Country:US
Practice Address - Phone:479-782-3005
Practice Address - Fax:479-494-7490
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR3933122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist