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General NPI Number Information
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NPI Number | 1396342846
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Entity Type | Organization
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Legal Business Name | MARK T LAVIN DDS PC
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Dates
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Enumeration Date | 10/07/2020
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Last Update Date | 10/07/2020
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Provider Practice Location Address
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Address Line | 3400 E 26TH ST
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City | SIOUX FALLS
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State | SD
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Zip | 57103-4183
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Country | US
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Telephone | 605-332-6300
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Fax | 605-332-6305
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Provider Business Mailing Address
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Address Line | 3400 E 26TH ST
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City | SIOUX FALLS
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State | SD
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Zip | 57103-4183
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Country | US
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Telephone | 605-332-6300
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Fax | 605-332-6305
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Authorized Official
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Title or Position | DENTIST / PERIODONTIST
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Name | DR. MARK THOMAS LAVIN
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Credential | DDS
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Telephone | 605-332-6300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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