MEDICARE: JOEY 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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1851124606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOEY DENTAL PLLC

Provider Business Mailing Address
First Line	:	3700 ROSS AVE APT 442
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204-5642
Country	:	US
Telephone Number	:	817-944-3606
Fax Number	:

Provider Business Practice Location Address
First Line	:	3600 MCKINNEY AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204-1437
Country	:	US
Telephone Number	:	214-969-7455
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. JOEY LE
Credential	:	DMD
Telephone Number	:	817-944-3606

Provider Enumeration Date	:	08/26/2024
Last Update Date	:	08/26/2024

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