MEDICARE: BEARCREEK DENTISTRY & ORTHODONTICS

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		TX

General Provider Information

NPI Number	:	1194188128
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEARCREEK DENTISTRY & ORTHODONTICS

Provider Business Mailing Address
First Line	:	4303 HIGHWAY 6 N
Second Line	:	SUITE A-1
City	:	HOUSTON
State	:	TX
Zip	:	77084-3446
Country	:	US
Telephone Number	:	281-855-9665
Fax Number	:

Provider Business Practice Location Address
First Line	:	4303 HIGHWAY 6 N
Second Line	:	SUITE A-1
City	:	HOUSTON
State	:	TX
Zip	:	77084-3446
Country	:	US
Telephone Number	:	281-855-9665
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. BRYAN T LE
Credential	:	DDS
Telephone Number	:	281-855-9665

Provider Enumeration Date	:	03/29/2016
Last Update Date	:	03/29/2016

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