Basic Information
| Provider Information | |||||||||
| NPI: | 1558413450 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LE | ||||||||
| FirstName: | TRAM | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 32904 NORTHSHIRE CIR | ||||||||
| Address2: | |||||||||
| City: | TEMECULA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925927200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8583368081 | ||||||||
| FaxNumber: | 9513033606 | ||||||||
| Practice Location | |||||||||
| Address1: | 31754 US HIGHWAY 79 S | ||||||||
| Address2: | |||||||||
| City: | TEMECULA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925926805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516945255 | ||||||||
| FaxNumber: | 9516945103 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 54971 | CA | Y | Dental Providers | Dentist | General Practice |
No ID Information.