Provider Demographics
NPI:1275733305
Name:LAVIE, MAURICIO (DMD)
Entity Type:Individual
Prefix:DR
First Name:MAURICIO
Middle Name:
Last Name:LAVIE
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 1:349 E NORTHFIELD RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-4802
Mailing Address - Country:US
Mailing Address - Phone:973-740-1277
Mailing Address - Fax:973-740-1808
Practice Address - Street 1:349 E NORTHFIELD RD
Practice Address - Street 2:SUITE 112
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-4802
Practice Address - Country:US
Practice Address - Phone:973-740-1277
Practice Address - Fax:973-740-1808
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DIO22612001223G0001X
NJ22DI022612001223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No1223G0001XDental ProvidersDentistGeneral Practice