Provider Demographics
NPI:1366601486
Name:LE, THIEN-THAO (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:THIEN-THAO
Middle Name:
Last Name:LE
Suffix:
Gender:F
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1420 28TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-1081
Mailing Address - Country:US
Mailing Address - Phone:303-444-2255
Mailing Address - Fax:720-565-1091
Practice Address - Street 1:1420 28TH ST STE 100
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1081
Practice Address - Country:US
Practice Address - Phone:303-444-2255
Practice Address - Fax:720-565-1091
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2024471223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery