MEDICARE: ACCUCARE COSMETIC AND FAMILY DENTISTRY, INC

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	1223G0001X	General Practice Dentistry	3528	NV

General Provider Information

NPI Number	:	1154694008
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCUCARE COSMETIC AND FAMILY DENTISTRY, INC

Provider Business Mailing Address
First Line	:	5431 S RAINBOW BLVD STE C3
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-1864
Country	:	US
Telephone Number	:	702-647-6453
Fax Number	:	702-873-7654

Provider Business Practice Location Address
First Line	:	5431 S RAINBOW BLVD STE C3
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-1864
Country	:	US
Telephone Number	:	702-647-6453
Fax Number	:	702-873-7654

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DAVID W. LEE
Credential	:	D.D.S.
Telephone Number	:	702-647-6453

Provider Enumeration Date	:	02/22/2012
Last Update Date	:	02/22/2012

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