MEDICARE: DR. MARK S LAVETTI DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	7017	MD

General Provider Information

NPI Number	:	1881600435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK S LAVETTI DDS

Provider Business Mailing Address
First Line	:	85 HIGH ST
Second Line	:	SUITE 6
City	:	WALDORF
State	:	MD
Zip	:	20602-2150
Country	:	US
Telephone Number	:	301-843-7303
Fax Number	:	301-645-6063

Provider Business Practice Location Address
First Line	:	85 HIGH ST
Second Line	:	SUITE 6
City	:	WALDORF
State	:	MD
Zip	:	20602-2150
Country	:	US
Telephone Number	:	301-843-7303
Fax Number	:	301-645-6063

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	07/08/2007

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