=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497971337
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GREGORY LEE TRNAVSKY D.D.S
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1240 S WESTLAKE BLVD STE 131
-----------------------------------------------------
City | WESTLAKE VILLAGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91361-1932
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-494-3772
-----------------------------------------------------
Fax | 805-494-3197
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1240 S WESTLAKE BLVD STE 131
-----------------------------------------------------
City | WESTLAKE VILLAGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91361-1932
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-494-3772
-----------------------------------------------------
Fax | 805-494-3197
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223E0200X
-----------------------------------------------------
Taxonomy Name | Endodontics
-----------------------------------------------------
License Number | 43665
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------