Provider Demographics
NPI:1366875221
Name:LE, ANTHONY NGUYEN (DMD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:NGUYEN
Last Name:LE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 MONROE ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-7656
Mailing Address - Country:US
Mailing Address - Phone:850-484-4844
Mailing Address - Fax:
Practice Address - Street 1:2850 MONROE ST
Practice Address - Street 2:SUITE 1
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-7656
Practice Address - Country:US
Practice Address - Phone:850-484-4844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN20335122300000X
FLDN 203351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentistGroup - Single Specialty