Provider Demographics
NPI:1518010362
Name:LAVORINI, ERNIE S (DDS)
Entity Type:Individual
Prefix:MR
First Name:ERNIE
Middle Name:S
Last Name:LAVORINI
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 1:363 15TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3303
Mailing Address - Country:US
Mailing Address - Phone:510-444-4334
Mailing Address - Fax:510-763-8326
Practice Address - Street 1:363 15TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-3303
Practice Address - Country:US
Practice Address - Phone:510-444-4334
Practice Address - Fax:510-763-8326
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA237371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice