Provider Demographics
NPI:1043858582
Name:DENTAL OFFICES OF TRAVIS LEE, DDS, INC.
Entity Type:Organization
Organization Name:DENTAL OFFICES OF TRAVIS LEE, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-312-5070
Mailing Address - Street 1:11600 WILSHIRE BLVD STE 10
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1775
Mailing Address - Country:US
Mailing Address - Phone:310-312-5070
Mailing Address - Fax:
Practice Address - Street 1:11600 WILSHIRE BLVD STE 10
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1775
Practice Address - Country:US
Practice Address - Phone:310-312-5070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental