MEDICARE: PURE SMILE DENTISTRY

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

General Provider Information

NPI Number	:	1073216214
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PURE SMILE DENTISTRY

Provider Business Mailing Address
First Line	:	981 N WALES RD STE 7
Second Line	:
City	:	NORTH WALES
State	:	PA
Zip	:	19454-1422
Country	:	US
Telephone Number	:	240-893-1973
Fax Number	:

Provider Business Practice Location Address
First Line	:	981 N WALES RD STE 7
Second Line	:
City	:	NORTH WALES
State	:	PA
Zip	:	19454-1422
Country	:	US
Telephone Number	:	240-893-1973
Fax Number	:

Authorized Official
Title or Position	:	OWNER DENTIST
Name	:	DR. EUN HYE LEE
Credential	:	DDS
Telephone Number	:	240-893-1973

Provider Enumeration Date	:	03/27/2023
Last Update Date	:	03/27/2023

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Directions to “PURE SMILE DENTISTRY ” Practice Location

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