MEDICARE: PROSTHOWORKS, P.C.

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	1223P0700X	Prosthodontics	21017	TX

General Provider Information

NPI Number	:	1992983191
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROSTHOWORKS, P.C.

Provider Business Mailing Address
First Line	:	PO BOX 662
Second Line	:
City	:	BEDFORD
State	:	TX
Zip	:	76095-0662
Country	:	US
Telephone Number	:	817-275-8651
Fax Number	:	817-275-6515

Provider Business Practice Location Address
First Line	:	1022 W MITCHELL ST
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76013-2543
Country	:	US
Telephone Number	:	817-275-8651
Fax Number	:	817-275-6515

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHIA-MING LEE
Credential	:	B.D.S., M.S.
Telephone Number	:	817-275-8651

Provider Enumeration Date	:	02/10/2008
Last Update Date	:	02/10/2008

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