Provider Demographics
NPI:1134477250
Name:ERIC J. LAVID, DDS, LLC
Entity Type:Organization
Organization Name:ERIC J. LAVID, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVID
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-331-1144
Mailing Address - Street 1:613 W CONWAY ST STE 101
Mailing Address - Street 2:
Mailing Address - City:RAYMORE
Mailing Address - State:MO
Mailing Address - Zip Code:64083-7301
Mailing Address - Country:US
Mailing Address - Phone:816-331-1144
Mailing Address - Fax:816-322-2271
Practice Address - Street 1:613 W CONWAY ST STE 101
Practice Address - Street 2:
Practice Address - City:RAYMORE
Practice Address - State:MO
Practice Address - Zip Code:64083-7301
Practice Address - Country:US
Practice Address - Phone:816-331-1144
Practice Address - Fax:816-322-2271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO016088122300000X
MO016137122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty