MEDICARE: CREATIVE DENTAL

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	122300000X	Dentist	4585	NV

General Provider Information

NPI Number	:	1295974780
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CREATIVE DENTAL

Provider Business Mailing Address
First Line	:	2585 S NELLIS BLVD STE 6
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-7548
Country	:	US
Telephone Number	:	702-641-0481
Fax Number	:	702-641-0128

Provider Business Practice Location Address
First Line	:	2585 S NELLIS BLVD STE 6
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-7548
Country	:	US
Telephone Number	:	702-641-0481
Fax Number	:	702-641-0128

Authorized Official
Title or Position	:	MANAGING DENTIST
Name	:	DR. JULIA LUU LE
Credential	:	DDS
Telephone Number	:	702-641-0481

Provider Enumeration Date	:	02/06/2009
Last Update Date	:	02/06/2009

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Directions to “CREATIVE DENTAL ” Practice Location

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