Provider Demographics
NPI:1598922551
Name:LEE, TRAVIS H (DDS)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:H
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48740122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist