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General NPI Number Information
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NPI Number | 1669597894
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Entity Type | Organization
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Legal Business Name | LEE D TATRO DDS
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 923 W DIXIE AVE
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City | LEESBURG
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State | FL
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Zip | 34748
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Country | US
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Telephone | 352-728-2639
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Fax | 352-728-5739
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Provider Business Mailing Address
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Address Line | 923 W DIXIE AVE
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City | LEESBURG
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State | FL
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Zip | 34748
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Country | US
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Telephone | 352-728-2639
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Fax | 352-728-5739
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Authorized Official
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Title or Position | PRESIDENT DENTIST
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Name | LEE D TATRO
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Credential | DDS
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Telephone | 352-728-2637
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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 | 6491
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License Number State | FL
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