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 NPI 1730177619
Title
President
Phone
(817) 786-8621

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

National Provider Directory

Locations

305 W Euless Blvd
Ste 100
Euless, TX 76040
Phone (817) 793-0013

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry
Group: 193400000X SINGLE SPECIALTY GROUP
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

IdentifierTypeStateIssuer
158687715MedicaidTX

Other providers in Euless, TX

All providers in Euless, TX · General Practice Dentistry in Texas

Sources for this page

Verify at the official NPI Registry.