Provider Demographics
NPI:1437286663
Name:AVANT, SONDRA LAVELLE (DDS, MS)
Entity Type:Individual
Prefix:
First Name:SONDRA
Middle Name:LAVELLE
Last Name:AVANT
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 DUNLAWTON AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-4237
Mailing Address - Country:US
Mailing Address - Phone:386-304-4620
Mailing Address - Fax:386-304-4618
Practice Address - Street 1:731 DUNLAWTON AVE STE 105
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-4237
Practice Address - Country:US
Practice Address - Phone:386-304-4620
Practice Address - Fax:386-304-4618
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN136061223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics