Provider Demographics
NPI:1770851768
Name:LSPH, PLLC
Entity Type:Organization
Organization Name:LSPH, PLLC
Other - Org Name:LEO DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:TAE
Authorized Official - Middle Name:CHUL
Authorized Official - Last Name:HO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:860-342-4141
Mailing Address - Street 1:553 PORTLAND COBALT RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06480-1968
Mailing Address - Country:US
Mailing Address - Phone:860-342-4141
Mailing Address - Fax:
Practice Address - Street 1:5607 UVALDE RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77049-4523
Practice Address - Country:US
Practice Address - Phone:917-687-4425
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty