MEDICARE: LOTUS DENTAL PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	1223P0221X	Pediatric Dentistry
2	1223P0300X	Periodontics
3	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry
4	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1417260647
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOTUS DENTAL PA

Provider Business Mailing Address
First Line	:	2106 N 11TH ST
Second Line	:
City	:	BEAUMONT
State	:	TX
Zip	:	77703-4912
Country	:	US
Telephone Number	:	409-898-1748
Fax Number	:

Provider Business Practice Location Address
First Line	:	2106 N 11TH ST
Second Line	:
City	:	BEAUMONT
State	:	TX
Zip	:	77703-4912
Country	:	US
Telephone Number	:	409-898-1748
Fax Number	:

Authorized Official
Title or Position	:	D.D.S.
Name	:	DR. KHOA T LE
Credential	:
Telephone Number	:	409-466-7093

Provider Enumeration Date	:	07/16/2010
Last Update Date	:	07/16/2010

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Directions to “LOTUS DENTAL PA ” Practice Location

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