Brian Le Ta, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

DE60980113 Issued in WA

Practice address

510 Washington Ave N
Kent, WA 98032-4453

Phone

(919) 740-7012

NPI assigned

May 24, 2019

Last updated

Aug 6, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/cdf42bb0-51f6-4504-b5a7-cccb830ef48f/

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

• Texas Native Health

  • Federally Qualified Health Center (FQHC)
  • Dallas, TX
  • NPI 1710108923
  Medicare reassignment NPD
• Willamette Dental Group, P.C.

  • Dentist
  • Kent, WA
  • NPI 1801711270
  NPD (past)

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

{
    "created_epoch": "1558656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565049600000",
    "number": "1750948790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9128 PALM BAY CIR",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276177776",
            "telephone_number": "919-740-7012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 WASHINGTON AVE N",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980324453",
            "telephone_number": "919-740-7012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TA",
        "first_name": "BRIAN",
        "middle_name": "LE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-05-24",
        "last_updated": "2019-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE60980113",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Danielle Sycks
• Yvette Melinda Sylvander Novak, LMP
• Mary Genevieve Syslo, LICSW
• Adam Craig Szajman, DDS
• Nicholas Szczepanski
• Thi Tuyet Mai Ta, MD
• Juleah R. Russek Tabak, ND
• Amber Tabares
• Ashleigh Gaven Adriano Tagupa
• Mary Jean Tahlequah, LMP,COMP,CNMT,SI

• Dentist in Kent, WA
• Providers in Kent, WA by specialty
• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.