Healthcare Provider Details

I. General information

NPI: 1720029754
Provider Name (Legal Business Name): LANNY R GARVAR DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7401 N UNIVERSITY DR 102
TAMARAC FL
33321-2979
US

IV. Provider business mailing address

7401 N UNIVERSITY DR 102
TAMARAC FL
33321-2979
US

V. Phone/Fax

Practice location:
  • Phone: 954-721-7990
  • Fax: 954-720-9484
Mailing address:
  • Phone: 954-721-7990
  • Fax: 954-720-9484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberDN0005375
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: