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General NPI Number Information
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NPI Number | 1013118686
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Entity Type | Organization
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Legal Business Name | LEKAVICH DENTAL CORPORATION
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 10/03/2007
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Provider Practice Location Address
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Address Line | 217 PALOS VERDES BLVD #105
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City | REDONDO BEACH
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State | CA
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Zip | 90277-5820
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Country | US
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Telephone | 310-373-5616
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Fax | 310-872-5459
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Provider Business Mailing Address
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Address Line | 217 PALOS VERDES BLVD #105
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City | REDONDO BEACH
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State | CA
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Zip | 90277-5820
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Country | US
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Telephone | 310-373-5616
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Fax | 310-872-5459
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Authorized Official
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Title or Position | PRESIDENT
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Name | TIMOTHY FLORAN LEKAVICH
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Credential | D.D.S.
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Telephone | 310-373-5616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 38866
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License Number State | CA
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