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General NPI Number Information
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NPI Number | 1902678923
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Entity Type | Organization
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Legal Business Name | ALLEN MODERN DENTAL PLLC
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Dates
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Enumeration Date | 10/24/2023
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Last Update Date | 10/24/2023
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Provider Practice Location Address
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Address Line | 960 RIDGEVIEW DR STE 100
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City | ALLEN
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State | TX
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Zip | 75013-5543
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Country | US
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Telephone | 214-384-5748
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Fax |
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Provider Business Mailing Address
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Address Line | 120 E FM 544 STE 72
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City | MURPHY
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State | TX
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Zip | 75094-4035
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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 | MANAGING MEMBER
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Name | DR. LAN CHI LE
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Credential | DDS
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Telephone | 214-384-5748
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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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