Individual
DR. BRIAN LE TA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
510 WASHINGTON AVE N, KENT, WA 98032-4453
(919) 740-7012
Mailing address
9128 PALM BAY CIR, RALEIGH, NC 27617-7776
(919) 740-7012
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DE60980113
WA
Other
Enumeration date
05/24/2019
Last updated
08/06/2019
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