| Blossom Smile Dental, Pllc | |
|
305 W Euless Blvd Ste 100 Euless TX 76040-3842 | |
| (817) 793-0013 | |
| (888) 600-6547 |
| Full Name | Blossom Smile Dental, Pllc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 305 W Euless Blvd Ste 100, Euless, Texas |
| Authorized Official Name and Position | Brian Le (PRESIDENT) |
| Authorized Official Contact | 8177868621 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Blossom Smile Dental, Pllc 305 W Euless Blvd Ste 100 Euless TX 76040-3842 Ph: (817) 786-8621 | Blossom Smile Dental, Pllc 305 W Euless Blvd Ste 100 Euless TX 76040-3842 Ph: (817) 793-0013 |
| NPI Number | 1285159137 |
|---|---|
| Provider Enumeration Date | 08/11/2017 |
| Last Update Date | 03/01/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285159137 | NPI | - | NPPES |
| 158687715 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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