Provider Demographics
NPI:1467541540
Name:LAVINO, SEBASTIAN S (DDS)
Entity Type:Individual
Prefix:
First Name:SEBASTIAN
Middle Name:S
Last Name:LAVINO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 GREGORY LANE
Mailing Address - Street 2:SUITE 142
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523
Mailing Address - Country:US
Mailing Address - Phone:925-689-7122
Mailing Address - Fax:925-689-1056
Practice Address - Street 1:401 GREGORY LANE
Practice Address - Street 2:SUITE 142
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523
Practice Address - Country:US
Practice Address - Phone:925-689-7122
Practice Address - Fax:925-689-1056
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40458122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist