Provider Demographics
NPI:1497839856
Name:LE, PHUONG FERN (DMD)
Entity type:Individual
Prefix:DR
First Name:PHUONG
Middle Name:FERN
Last Name:LE
Suffix:
Gender:F
Credentials:DMD
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Mailing Address - Street 1:65 NEILSON ST
Mailing Address - Street 2:SUITE 135
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-2491
Mailing Address - Country:US
Mailing Address - Phone:831-768-9365
Mailing Address - Fax:831-768-9393
Practice Address - Street 1:65 NEILSON ST
Practice Address - Street 2:SUITE 135
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-2491
Practice Address - Country:US
Practice Address - Phone:831-768-9365
Practice Address - Fax:831-768-9393
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2013-01-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA513901223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics