MEDICARE: DR. SUSANNE YVONNE LAVOIE 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	DEN02060	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982716064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSANNE YVONNE LAVOIE DDS

Provider Business Mailing Address
First Line	:	1481 ATWOOD AVE
Second Line	:	SUITE #3
City	:	JOHNSTON
State	:	RI
Zip	:	02919-4800
Country	:	US
Telephone Number	:	401-228-7550
Fax Number	:	401-228-7560

Provider Business Practice Location Address
First Line	:	1481 ATWOOD AVE
Second Line	:	SUITE #3
City	:	JOHNSTON
State	:	RI
Zip	:	02919-4800
Country	:	US
Telephone Number	:	401-228-7550
Fax Number	:	401-228-7560

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	01/04/2012

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