Provider Demographics
NPI:1255483509
Name:LAVANA, NIKHIL (DMD)
Entity Type:Individual
Prefix:DR
First Name:NIKHIL
Middle Name:
Last Name:LAVANA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 MORELAND GREEN DR
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-1075
Mailing Address - Country:US
Mailing Address - Phone:508-752-9921
Mailing Address - Fax:
Practice Address - Street 1:581 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:PAXTON
Practice Address - State:MA
Practice Address - Zip Code:01612-1382
Practice Address - Country:US
Practice Address - Phone:508-755-2905
Practice Address - Fax:508-798-8155
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA200921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice