Provider Demographics
NPI:1225562820
Name:QTL DENTAL PLLC
Entity Type:Organization
Organization Name:QTL DENTAL PLLC
Other - Org Name:QTL DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:QUYEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:2545-231-4948
Mailing Address - Street 1:121 N 31ST ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504-2421
Mailing Address - Country:US
Mailing Address - Phone:254-231-4948
Mailing Address - Fax:254-231-4930
Practice Address - Street 1:121 N 31ST ST
Practice Address - Street 2:SUITE A
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-2421
Practice Address - Country:US
Practice Address - Phone:254-231-4948
Practice Address - Fax:254-231-4930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty