MEDICARE: DR. BRIAN LE D.M.D.

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	23046	TX

General Provider Information

NPI Number	:	1033323910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN LE D.M.D.

Provider Business Mailing Address
First Line	:	2104 NORTH FRAZIER ST., #D
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77301-6622
Country	:	US
Telephone Number	:	936-756-5080
Fax Number	:

Provider Business Practice Location Address
First Line	:	2104 NORTH FRAZIER ST., #D
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77301-6622
Country	:	US
Telephone Number	:	936-756-5080
Fax Number	:

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

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	10/10/2008

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