Organization
BLOSSOM SMILE DENTAL, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN LE DDS (PRESIDENT)
(817) 786-8621
Entity
Organization
Contact information
Practice address
305 W EULESS BLVD STE 100, EULESS, TX 76040-3842
(817) 793-0013
(888) 600-6547
Mailing address
305 W EULESS BLVD STE 100, EULESS, TX 76040-3842
(817) 786-8621
(888) 600-6547
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
158687715
—
TX
Enumeration date
08/11/2017
Last updated
03/01/2018
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