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General NPI Number Information
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NPI Number | 1548724560
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Entity Type | Organization
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Legal Business Name | PURE DENTAL STUDIO LLC
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Dates
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Enumeration Date | 01/23/2019
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Last Update Date | 02/27/2024
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Provider Practice Location Address
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Address Line | 9101 JONES RD STE A
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City | HOUSTON
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State | TX
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Zip | 77065-4403
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Country | US
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Telephone | 832-302-2354
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Fax |
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Provider Business Mailing Address
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Address Line | 9101 JONES RD STE A
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City | HOUSTON
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State | TX
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Zip | 77065-4403
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Country | US
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Telephone | 832-604-7737
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Fax | 832-604-7620
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRYAN T LE
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Credential | DDS
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Telephone | 832-604-7737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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