Provider Demographics
NPI:1396188645
Name:LAVOIE, NICHOLAS A (DDS, MPH, MA)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:A
Last Name:LAVOIE
Suffix:
Gender:M
Credentials:DDS, MPH, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 FORGE RD
Mailing Address - Street 2:
Mailing Address - City:ASSONET
Mailing Address - State:MA
Mailing Address - Zip Code:02702-1128
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2200 GAR HWY STE 2A
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:MA
Practice Address - Zip Code:02777-3935
Practice Address - Country:US
Practice Address - Phone:508-233-3341
Practice Address - Fax:508-286-8600
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN032441223P0221X
MADN18567591223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry