MEDICARE: PURE DENTAL STUDIO LLC

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
2	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1548724560
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PURE DENTAL STUDIO LLC

Provider Business Mailing Address
First Line	:	9101 JONES RD STE A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77065-4403
Country	:	US
Telephone Number	:	832-604-7737
Fax Number	:	832-604-7620

Provider Business Practice Location Address
First Line	:	9101 JONES RD STE A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77065-4403
Country	:	US
Telephone Number	:	832-302-2354
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BRYAN T LE
Credential	:	DDS
Telephone Number	:	832-604-7737

Provider Enumeration Date	:	01/23/2019
Last Update Date	:	02/27/2024

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Directions to “PURE DENTAL STUDIO LLC ” Practice Location

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