Provider Demographics
NPI:1053156547
Name:LE, ANDY DINH (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDY
Middle Name:DINH
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 1:1999 LINCOLN DR STE 102
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-9120
Mailing Address - Country:US
Mailing Address - Phone:352-327-1347
Mailing Address - Fax:
Practice Address - Street 1:1999 LINCOLN DR STE 102
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-9120
Practice Address - Country:US
Practice Address - Phone:352-327-1347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL29153122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist