Healthcare Provider Details

I. General information

NPI: 1013042027
Provider Name (Legal Business Name): MARSHALL T. LAVIN, DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 S SOUTHEASTERN AVE SUITE 100
SIOUX FALLS SD
57103-3381
US

IV. Provider business mailing address

1710 S SOUTHEASTERN AVE SUITE 100
SIOUX FALLS SD
57103-3381
US

V. Phone/Fax

Practice location:
  • Phone: 605-334-7979
  • Fax: 605-334-2275
Mailing address:
  • Phone: 605-334-7979
  • Fax: 605-334-2275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberM865
License Number StateSD

VIII. Authorized Official

Name: MARSHALL LAVIN
Title or Position: DOCTOR
Credential: DDS
Phone: 605-334-7979