Provider Demographics
NPI:1285159962
Name:LE, RYAN (DDS)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
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 1:4112 WINGHAM PL
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95135-1050
Mailing Address - Country:US
Mailing Address - Phone:408-892-4310
Mailing Address - Fax:
Practice Address - Street 1:5945 ALMADEN EXPY STE 160
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95120-5923
Practice Address - Country:US
Practice Address - Phone:408-927-7378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101805122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist