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General NPI Number Information
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NPI Number | 1821329764
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Entity Type | Organization
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Legal Business Name | BEAUMONT LOTUS DENTAL
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Dates
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Enumeration Date | 01/15/2010
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Last Update Date | 01/15/2010
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Provider Practice Location Address
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Address Line | 2106 N 11TH ST
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City | BEAUMONT
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State | TX
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Zip | 77703-4912
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Country | US
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Telephone | 832-274-2309
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Fax |
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Provider Business Mailing Address
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Address Line | 2106 N 11TH ST
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City | BEAUMONT
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State | TX
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Zip | 77703-4912
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | D.D.S.
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Name | KHOA TRONG LE
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Credential |
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Telephone | 409-466-7093
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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 | 21351
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License Number State | TX
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