Provider Demographics
NPI:1205966868
Name:TATRO, LEE D (DDS)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:D
Last Name:TATRO
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 1:923 W DIXIE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748
Mailing Address - Country:US
Mailing Address - Phone:352-728-2639
Mailing Address - Fax:352-728-5739
Practice Address - Street 1:923 W DIXIE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748
Practice Address - Country:US
Practice Address - Phone:352-728-2639
Practice Address - Fax:352-728-5739
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6491122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist