Provider Demographics
NPI:1437904075
Name:KATRINA M. LAVALLIERE, D.D.S, P.L.L.C.
Entity Type:Organization
Organization Name:KATRINA M. LAVALLIERE, D.D.S, P.L.L.C.
Other - Org Name:LAVALLIERE DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVALLIERE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-962-4215
Mailing Address - Street 1:7318 EASEN CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-6110
Mailing Address - Country:US
Mailing Address - Phone:704-962-4215
Mailing Address - Fax:
Practice Address - Street 1:118 S COLONIAL AVE UNIT B
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1465
Practice Address - Country:US
Practice Address - Phone:704-332-6200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-18
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty