Provider Demographics
NPI:1285880609
Name:TOWER DENTAL
Entity type:Organization
Organization Name:TOWER DENTAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-241-8206
Mailing Address - Street 1:512 E SAINT LOUIS AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-2509
Mailing Address - Country:US
Mailing Address - Phone:702-894-9858
Mailing Address - Fax:702-894-4175
Practice Address - Street 1:512 E SAINT LOUIS AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-2509
Practice Address - Country:US
Practice Address - Phone:702-894-9858
Practice Address - Fax:702-894-4175
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVID LEE DMD APC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV35181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty