MEDICARE: DR. NGAN LE AMBRIZ DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	0554931	NY
2	390200000X	Student in an Organized Health Care Education/Training Program	50-055493	NY
3	122300000X	Dentist	30996	TX

General Provider Information

NPI Number	:	1043523582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NGAN LE AMBRIZ DDS

Provider Business Mailing Address
First Line	:	8066 PARK LN APT 1004
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-5969
Country	:	US
Telephone Number	:	510-557-2705
Fax Number	:

Provider Business Practice Location Address
First Line	:	8066 PARK LN APT 1004
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-5969
Country	:	US
Telephone Number	:	510-557-2705
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2010
Last Update Date	:	06/02/2016

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