Individual provider Active NPI

Vuong Brandon Le

  • Dentist
  • Waco, TX
National Provider Identifier
1477243327
Registry record updated Sep 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
40420 Issued in TX
Practice address
6234 N State Highway 6
Waco, TX 76712-2672
Phone
(254) 214-6454
NPI assigned
May 12, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Dentist 122300000X 40420 TX Primary

Addresses

Primary practice location

6234 N State Highway 6
Waco, TX 76712-2672

Mailing address

6234 N State Highway 6
Waco, TX 76712-2672
Phone (254) 214-6454

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240910001993 TX Practitioner - Dentist 8022558691 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
40420TXMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Heart of Texas Community Health Center Inc Current Accepting new patients
Heart of Texas Community Health Center, Inc. CurrentSince Jul 15, 2024 Accepting new patients
McLennan County Medical Education and Research Foundation Current Accepting new patients
Heart of Texas Community Health Center, Inc CurrentSince Jul 15, 2024 Accepting new patients

Locations

500 Johnson Dr
McGregor, TX 76657
Phone (254) 313-5200

1600 Providence Dr
Waco, TX 76707
Phone (254) 313-4200

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1683849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726704000000",
    "number": "1477243327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6234 N STATE HIGHWAY 6",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767122672",
            "telephone_number": "254-214-6454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6234 N STATE HIGHWAY 6",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767122672",
            "telephone_number": "254-214-6454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LE",
        "first_name": "VUONG",
        "middle_name": "BRANDON",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-05-12",
        "last_updated": "2024-09-19",
        "certification_date": "2024-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "40420",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waco, TX

Sources for this page

Verify at the official NPI Registry.