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General NPI Number Information
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NPI Number | 1225562820
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Entity Type | Organization
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Legal Business Name | QTL DENTAL PLLC
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Dates
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Enumeration Date | 04/20/2017
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Last Update Date | 04/20/2017
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Provider Practice Location Address
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Address Line | 121 N 31ST ST SUITE A
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City | TEMPLE
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State | TX
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Zip | 76504-2421
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Country | US
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Telephone | 254-231-4948
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Fax | 254-231-4930
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Provider Business Mailing Address
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Address Line | 121 N 31ST ST SUITE A
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City | TEMPLE
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State | TX
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Zip | 76504-2421
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Country | US
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Telephone | 254-231-4948
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Fax | 254-231-4930
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Authorized Official
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Title or Position | OWNER
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Name | DR. QUYEN LEE
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Credential | DDS
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Telephone | 25452314948
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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