Provider Demographics
NPI:1538540851
Name:LE, CHANH MINH (DDS)
Entity type:Individual
Prefix:DR
First Name:CHANH
Middle Name:MINH
Last Name:LE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7225 US 31 S
Mailing Address - Street 2:SUITE G
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-8685
Mailing Address - Country:US
Mailing Address - Phone:317-300-0356
Mailing Address - Fax:
Practice Address - Street 1:7225 US 31 S
Practice Address - Street 2:SUITE G
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-8685
Practice Address - Country:US
Practice Address - Phone:317-300-0356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-11
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012347A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice