MEDICARE: NICK LE DDS 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

General Provider Information

NPI Number	:	1831928845
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NICK LE DDS PLLC

Provider Business Mailing Address
First Line	:	8620 CALMONT AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-2802
Country	:	US
Telephone Number	:	817-244-6315
Fax Number	:	817-244-4530

Provider Business Practice Location Address
First Line	:	8620 CALMONT AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-2802
Country	:	US
Telephone Number	:	817-244-6315
Fax Number	:	817-244-4530

Authorized Official
Title or Position	:	DENTIST
Name	:	NICK LE
Credential	:	DDS
Telephone Number	:	817-244-6315

Provider Enumeration Date	:	07/29/2024
Last Update Date	:	07/29/2024

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