MEDICARE: DR. BRIAN T LE D.D.S.

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730177619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN T LE D.D.S.

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	03/01/2018

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Directions to “ DR. BRIAN T LE D.D.S.” Practice Location

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