MEDICARE: DR. MICHAEL EUGENE LAVINDER D.D.S.

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	0401005343	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9181658	OTHER	VA	DORAL PROVIDER FOR MEDICA
2	816711	OTHER	VA	UNITED CONCORDIA
3	066633	OTHER	VA	ANTHEM

General Provider Information

NPI Number	:	1558414474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL EUGENE LAVINDER D.D.S.

Provider Business Mailing Address
First Line	:	4940 KINGS MOUNTAIN RD
Second Line	:
City	:	COLLINSVILLE
State	:	VA
Zip	:	24078-1826
Country	:	US
Telephone Number	:	276-647-1494
Fax Number	:	276-647-1142

Provider Business Practice Location Address
First Line	:	4940 KINGS MOUNTAIN RD
Second Line	:
City	:	COLLINSVILLE
State	:	VA
Zip	:	24078-1826
Country	:	US
Telephone Number	:	276-647-1494
Fax Number	:	276-647-1142

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	01/18/2026

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