Provider Demographics
NPI:1013042027
Name:MARSHALL T. LAVIN, DDS, PC
Entity Type:Organization
Organization Name:MARSHALL T. LAVIN, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-334-7979
Mailing Address - Street 1:1710 S SOUTHEASTERN AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-3381
Mailing Address - Country:US
Mailing Address - Phone:605-334-7979
Mailing Address - Fax:605-334-2275
Practice Address - Street 1:1710 S SOUTHEASTERN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57103-3381
Practice Address - Country:US
Practice Address - Phone:605-334-7979
Practice Address - Fax:605-334-2275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM8651223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty