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General NPI Number Information
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NPI Number | 1356808711
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Entity Type | Organization
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Legal Business Name | TOP WEST TOWER IMPLANT CENTER INC
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Dates
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Enumeration Date | 02/21/2019
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Last Update Date | 09/07/2021
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Provider Practice Location Address
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Address Line | 2707 W OLYMPIC BLVD STE 202
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City | LOS ANGELES
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State | CA
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Zip | 90006-2859
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Country | US
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Telephone | 213-382-4336
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Fax | 213-382-4993
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Provider Business Mailing Address
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Address Line | 2707 W OLYMPIC BLVD STE 202
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City | LOS ANGELES
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State | CA
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Zip | 90006-2859
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Country | US
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Telephone | 213-382-4336
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Fax | 213-382-4993
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Authorized Official
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Title or Position | OWNER
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Name | ANDRE M LEE
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Credential | DDS
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Telephone | 213-382-4336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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