MEDICARE: IBRITE DENTAL PLLC

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	21298	TX

General Provider Information

NPI Number	:	1558808030
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IBRITE DENTAL PLLC

Provider Business Mailing Address
First Line	:	1114 E SEMINARY DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76115-2830
Country	:	US
Telephone Number	:	817-921-0883
Fax Number	:	888-600-6547

Provider Business Practice Location Address
First Line	:	1114 E SEMINARY DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76115-2830
Country	:	US
Telephone Number	:	817-921-0883
Fax Number	:	888-600-6547

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BRIAN LE
Credential	:	DDS
Telephone Number	:	817-921-0883

Provider Enumeration Date	:	01/23/2017
Last Update Date	:	01/23/2017

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Directions to “IBRITE DENTAL PLLC ” Practice Location

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