Provider Demographics
NPI:1467658997
Name:SAM A. LAVI DMD INC
Entity Type:Organization
Organization Name:SAM A. LAVI DMD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHRAM
Authorized Official - Middle Name:ABRAHAM
Authorized Official - Last Name:LAVI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:213-623-2212
Mailing Address - Street 1:617 S OLIVE ST STE 800
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90014-1629
Mailing Address - Country:US
Mailing Address - Phone:213-623-2212
Mailing Address - Fax:
Practice Address - Street 1:617 S OLIVE ST STE 800
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90014-1629
Practice Address - Country:US
Practice Address - Phone:213-623-2212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA419391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA41939OtherDENTAL LICENCE