Blossom Smile Dental, PLLC
Organization Active NPI General Practice Dentistry · Euless, TX
NPI 1285159137 · NPPES record last updated Mar 1, 2018
Key facts
- NPI
- 1285159137
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Practice Dentistry 1223G0001X
- Legal business name
- BLOSSOM SMILE DENTAL, PLLC
- Practice address
- 305 W Euless Blvd Ste 100
Euless, TX 76040-3842 - Phone
- (817) 793-0013
- Fax
- (888) 600-6547
- NPI assigned
- Aug 11, 2017
- Organization subpart
- No
Authorized official
- Name
- Brian Le, DDS
- Title
- President
- Phone
- (817) 786-8621
Practitioners 1
-
Brian T Le, D.D.S.
National Provider Directory
Locations
305 W Euless Blvd
Ste 100
Euless, TX 76040
Phone (817) 793-0013
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry |
1223G0001X | Yes |
Addresses
Primary practice location
305 W Euless Blvd Ste 100
Euless, TX 76040-3842
Mailing address
305 W Euless Blvd Ste 100
Euless, TX 76040-3842
Phone (817) 786-8621
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 158687715 | Medicaid | TX |
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All providers in Euless, TX · General Practice Dentistry in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 1, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.