MEDICARE: BEAUMONT LOTUS DENTAL

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	21351	TX

General Provider Information

NPI Number	:	1821329764
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAUMONT LOTUS DENTAL

Provider Business Mailing Address
First Line	:	2106 N 11TH ST
Second Line	:
City	:	BEAUMONT
State	:	TX
Zip	:	77703-4912
Country	:	US
Telephone Number	:
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	:	832-274-2309
Fax Number	:

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

Provider Enumeration Date	:	01/15/2010
Last Update Date	:	01/15/2010

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Directions to “BEAUMONT LOTUS DENTAL ” Practice Location

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