Provider Demographics
NPI:1992898621
Name:LE, TIFFANI TRINH (DDS)
Entity type:Individual
Prefix:DR
First Name:TIFFANI
Middle Name:TRINH
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 1:3209 DELTA RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95135-1111
Mailing Address - Country:US
Mailing Address - Phone:408-531-5486
Mailing Address - Fax:408-254-2505
Practice Address - Street 1:1911 TULLY ROAD, SUITE A
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122
Practice Address - Country:US
Practice Address - Phone:408-254-2877
Practice Address - Fax:408-254-2505
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA487371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice