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General NPI Number Information
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NPI Number | 1538574157
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Entity Type | Organization
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Legal Business Name | PAUL B. LAVINE, D.D.S. P.A.
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Dates
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Enumeration Date | 06/23/2014
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Last Update Date | 06/23/2014
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Provider Practice Location Address
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Address Line | 201 NORTH ST
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City | ELKTON
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State | MD
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Zip | 21921-5512
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Country | US
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Telephone | 410-398-0250
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Fax |
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Provider Business Mailing Address
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Address Line | 201 NORTH ST
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City | ELKTON
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State | MD
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Zip | 21921-5512
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Country | US
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Telephone | 410-398-0250
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Fax |
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Authorized Official
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Title or Position | GENERAL DENTIST, OWNER
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Name | DR. PAUL B LAVINE
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Credential | D.D.S.
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Telephone | 410-398-0250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 15500
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License Number State | MD
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