MEDICARE: DR. THAI LE D.D.S

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	24733	TX

General Provider Information

NPI Number	:	1871720912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THAI LE D.D.S

Provider Business Mailing Address
First Line	:	5401 CORONATION DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017-4967
Country	:	US
Telephone Number	:	682-564-4936
Fax Number	:

Provider Business Practice Location Address
First Line	:	2880 N. FM 157
Second Line	:	SUITE 102
City	:	MANSFIELD
State	:	TX
Zip	:	76063
Country	:	US
Telephone Number	:	817-473-6200
Fax Number	:

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

Provider Enumeration Date	:	06/16/2009
Last Update Date	:	06/16/2009

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