Provider Demographics
NPI:1962911909
Name:LE, THANH THEIN NGOC (DDS)
Entity type:Individual
Prefix:DR
First Name:THANH
Middle Name:THEIN 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 1:20261 MORRISTOWN CIR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-5320
Mailing Address - Country:US
Mailing Address - Phone:714-548-6828
Mailing Address - Fax:
Practice Address - Street 1:1821 S SAN JACINTO AVE STE D
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-5608
Practice Address - Country:US
Practice Address - Phone:951-654-7744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-21
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1016791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice