Provider Demographics
NPI:1598550097
Name:LE, MELINDA XUAN (DMD)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:XUAN
Last Name:LE
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4230 SUGAR MILL DR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-6859
Mailing Address - Country:US
Mailing Address - Phone:678-770-9872
Mailing Address - Fax:
Practice Address - Street 1:200 5TH AVE FL 3
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-8759
Practice Address - Country:US
Practice Address - Phone:617-480-6355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program