Trang T Le, DMD
Individual provider Active NPI Dentist · Hatch, NM
NPI 1609073378 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1609073378
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DD2879 (NM)
- Practice address
- 255 Hwy 187
Hatch, NM 87937 - Phone
- (505) 267-3286
- Fax
- (505) 267-1747
- NPI assigned
- Jun 27, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151027000129 | NM | Order and Referring Only - Oral Surgery |
1759690597 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DD2879 | NM | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wisteria Dental LLC | Current | Accepting new patients |
Locations
1904 Wellspring Ave SE
Ste 101
Rio Rancho, NM 87124
Phone (505) 896-6654
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DD2879 | NM | Yes |
Addresses
Primary practice location
255 Hwy 187
Hatch, NM 87937
Mailing address
P.O. Box 370
Hatch, NM 87937
Phone (505) 267-3286
Other providers in Hatch, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.