MEDICARE: BRYAN T LE DDS PA

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	25996	TX

General Provider Information

NPI Number	:	1487992830
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRYAN T LE DDS PA

Provider Business Mailing Address
First Line	:	4376 HIGHWAY 6 N
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77084-3447
Country	:	US
Telephone Number	:	281-856-0600
Fax Number	:

Provider Business Practice Location Address
First Line	:	4376 HIGHWAY 6 N
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77084-3447
Country	:	US
Telephone Number	:	281-856-0600
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRYAN TAO LE
Credential	:	D..D.S
Telephone Number	:	650-267-1797

Provider Enumeration Date	:	01/18/2013
Last Update Date	:	01/22/2013

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