Healthcare Provider Details

I. General information

NPI: 1356808711
Provider Name (Legal Business Name): TOP WEST TOWER IMPLANT CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2019
Last Update Date: 09/07/2021
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2707 W OLYMPIC BLVD STE 202
LOS ANGELES CA
90006-2859
US

IV. Provider business mailing address

2707 W OLYMPIC BLVD STE 202
LOS ANGELES CA
90006-2859
US

V. Phone/Fax

Practice location:
  • Phone: 213-382-4336
  • Fax: 213-382-4993
Mailing address:
  • Phone: 213-382-4336
  • Fax: 213-382-4993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: ANDRE M LEE
Title or Position: OWNER
Credential: DDS
Phone: 213-382-4336