Provider Demographics
NPI:1083760763
Name:SAINT LUKE'S DENTAL ASSOCIATES, INC
Entity Type:Organization
Organization Name:SAINT LUKE'S DENTAL ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:LAVIGNA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:216-368-7238
Mailing Address - Street 1:11201 SHAKER BLVD
Mailing Address - Street 2:SUITE 136
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44104-3869
Mailing Address - Country:US
Mailing Address - Phone:216-368-7238
Mailing Address - Fax:216-274-9954
Practice Address - Street 1:11201 SHAKER BLVD
Practice Address - Street 2:SUITE 136
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44104-3869
Practice Address - Country:US
Practice Address - Phone:216-368-7238
Practice Address - Fax:216-274-9954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH148471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1689665408OtherNPI
OH1871584870OtherNPI
OH1467443473OtherNPI