Provider Demographics
NPI:1326453853
Name:COURTNEY LAVIGNE DMD LLC
Entity Type:Organization
Organization Name:COURTNEY LAVIGNE DMD LLC
Other - Org Name:COURTNEY LAVIGNE DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LAVIGNE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-358-2122
Mailing Address - Street 1:109 ANDREW AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-3156
Mailing Address - Country:US
Mailing Address - Phone:508-358-2122
Mailing Address - Fax:508-358-9522
Practice Address - Street 1:109 ANDREW AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778-3156
Practice Address - Country:US
Practice Address - Phone:508-358-2122
Practice Address - Fax:508-358-9522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18563531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty