Provider Demographics
NPI:1992129696
Name:TOMMY C LE DDS, A PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:TOMMY C LE DDS, A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TOMMY
Authorized Official - Middle Name:CUONG
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-454-3340
Mailing Address - Street 1:1641 E 17TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-8535
Mailing Address - Country:US
Mailing Address - Phone:714-542-7400
Mailing Address - Fax:714-543-3536
Practice Address - Street 1:1641 E 17TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-8535
Practice Address - Country:US
Practice Address - Phone:714-542-7400
Practice Address - Fax:714-543-3536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-17
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57630122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty