MEDICARE: DR. DAVID ARCHIE LEAL DDS

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	16203	TX

General Provider Information

NPI Number	:	1942280094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID ARCHIE LEAL DDS

Provider Business Mailing Address
First Line	:	BUDGE DENTAL CLINIC
Second Line	:	3145 GARDEN AVE BLDG 1278
City	:	FORT SAM HOUSTON
State	:	TX
Zip	:	78234
Country	:	US
Telephone Number	:	210-808-3735
Fax Number	:	210-539-2084

Provider Business Practice Location Address
First Line	:	BUDGE DENTAL CLINIC
Second Line	:	3145 GARDEN AVE BLDG 1278
City	:	FORT SAM HOUSTON
State	:	TX
Zip	:	78234
Country	:	US
Telephone Number	:	210-808-3735
Fax Number	:	210-539-2084

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	11/04/2022

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