Individual provider Active NPI

Phuong B Le, DMD

  • General Practice Dentistry
  • Norcross, GA
National Provider Identifier
1851415319
Registry record updated Dec 17, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN013369 Issued in GA
Practice address
3985 Steve Reynolds Blvd
Building O, Suite 101
Norcross, GA 30093-3035
Phone
(678) 205-1308
Fax
(678) 205-1345
NPI assigned
Mar 19, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 17, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DN013369 GA Primary

Addresses

Primary practice location

3985 Steve Reynolds Blvd
Building O, Suite 101
Norcross, GA 30093-3035

Mailing address

2993 Arbor Chase
Decatur, GA 30033-1800
Phone (770) 908-8711

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
DN013369GAMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1197849600000",
    "number": "1851415319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2993 ARBOR CHASE",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300331800",
            "telephone_number": "770-908-8711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3985 STEVE REYNOLDS BLVD",
            "address_2": "BUILDING O, SUITE 101",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "300933035",
            "telephone_number": "678-205-1308",
            "fax_number": "678-205-1345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LE",
        "first_name": "PHUONG",
        "middle_name": "B",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-19",
        "last_updated": "2007-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN013369",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Norcross, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.