MEDICARE: TOWER DENTAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	3518	NV

General Provider Information

NPI Number	:	1285880609
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOWER DENTAL

Provider Business Mailing Address
First Line	:	512 E SAINT LOUIS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-2509
Country	:	US
Telephone Number	:	702-894-9858
Fax Number	:	702-894-4175

Provider Business Practice Location Address
First Line	:	512 E SAINT LOUIS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-2509
Country	:	US
Telephone Number	:	702-894-9858
Fax Number	:	702-894-4175

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID LEE
Credential	:	DMD
Telephone Number	:	702-241-8206

Provider Enumeration Date	:	08/18/2008
Last Update Date	:	08/18/2008

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