MEDICARE: SAINT LUKE'S DENTAL ASSOCIATES, INC

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	122300000X	Dentist	19620	OH

General Provider Information

NPI Number	:	1992769301
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAINT LUKE'S DENTAL ASSOCIATES, INC

Provider Business Mailing Address
First Line	:	11201 SHAKER BLVD
Second Line	:	#136
City	:	CLEVELAND
State	:	OH
Zip	:	44104-3869
Country	:	US
Telephone Number	:	216-791-8322
Fax Number	:

Provider Business Practice Location Address
First Line	:	11201 SHAKER BLVD
Second Line	:	#136
City	:	CLEVELAND
State	:	OH
Zip	:	44104-3869
Country	:	US
Telephone Number	:	216-791-8322
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WILLIAM F LAVIGNA
Credential	:	DDS
Telephone Number	:	216-368-7238

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	08/22/2020

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Directions to “SAINT LUKE'S DENTAL ASSOCIATES, INC ” Practice Location

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