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General NPI Number Information
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NPI Number | 1619463114
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Entity Type | Organization
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Legal Business Name | LAVU PLLC
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Dates
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Enumeration Date | 07/08/2018
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Last Update Date | 07/08/2018
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Provider Practice Location Address
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Address Line | 1007 W MITCHELL ST STE 201
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City | ARLINGTON
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State | TX
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Zip | 76013-2504
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Country | US
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Telephone | 817-330-8090
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Fax |
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Provider Business Mailing Address
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Address Line | 2001 SIMMONS RD
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City | FLOWER MOUND
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State | TX
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Zip | 75022-4431
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | SUSHMA LAVU
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Credential | DDS
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Telephone | 817-330-8090
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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 | 24206
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License Number State | TX
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