Provider Demographics
NPI:1669597894
Name:LEE D TATRO DDS
Entity type:Organization
Organization Name:LEE D TATRO DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:D
Authorized Official - Last Name:TATRO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:352-728-2637
Mailing Address - Street 1:923 W DIXIE AVE
Mailing Address - Street 2:
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:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6491122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty