Healthcare Provider Details

I. General information

NPI: 1639749385
Provider Name (Legal Business Name): TOP WEST TOWER IMPLANT CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2021
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:
Mailing address:
  • Phone: 213-382-4336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

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