MEDICARE: ALLURE SMILE DENTAL, P.A.

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	27083	TX

General Provider Information

NPI Number	:	1891230280
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLURE SMILE DENTAL, P.A.

Provider Business Mailing Address
First Line	:	2880 N. FM 157
Second Line	:	SUITE #102
City	:	MANSFIELD
State	:	TX
Zip	:	76063
Country	:	US
Telephone Number	:	817-473-6200
Fax Number	:	817-473-6207

Provider Business Practice Location Address
First Line	:	2880 N. FM 157
Second Line	:	SUITE #102
City	:	MANSFIELD
State	:	TX
Zip	:	76063
Country	:	US
Telephone Number	:	817-473-6200
Fax Number	:	817-473-6207

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MAN NGUYEN LE
Credential	:	D.D.S
Telephone Number	:	817-412-8601

Provider Enumeration Date	:	12/21/2016
Last Update Date	:	12/21/2016

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